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Revenue Cycle Management Services
in Lexington, KY
Qualigenix revenue cycle management runs eligibility, prior authorization, coding, claims, posting, denials and A/R for Lexington practices as one connected service.
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How Qualigenix Serves Lexington Practices
Qualigenix runs the revenue cycle for independent practices in Lexington, from single-provider offices to groups with several locations in Fayette County. Revenue usually leaks in five places: missed eligibility or authorization checks, coding and charge capture errors, unworked denials, patient balances, and payer underpayments. One Qualigenix team owns all five. Kentucky-wide rules, such as payment deadlines and interest on late claims, are covered on our page for revenue cycle management services in Kentucky. This page covers what a Lexington practice's revenue cycle runs into: the Medicaid plans in Fayette County, the coverage changes coming in 2027 and the Medicare plans local patients carry.
What revenue cycle management services does Qualigenix provide in Lexington?
Qualigenix covers the full revenue cycle for Lexington practices: insurance verification, prior authorizations, coding, billing, payment posting, denial management, A/R recovery and credentialing. One team works all payers, including Kentucky's five Medicaid plans, CGS Medicare and commercial insurers.
Pricing is a percentage of collections.
RCM for Fayette County's Medicaid Plans
A Lexington Medicaid patient belongs to one of five statewide managed care plans for 2026-2027: Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport by Molina Healthcare, UnitedHealthcare Community Plan or WellCare of Kentucky. Some members stay in fee-for-service Kentucky Medicaid. The revenue cycle starts by knowing which one pays.
Eligibility Before Every Visit
Plan assignment can change between visits. From January 1, 2027, many Kentucky Medicaid expansion adults ages 19 to 64 must show 80 hours a month of work or community engagement when they renew. A patient who misses that step can lose coverage at renewal. Qualigenix checks eligibility and plan assignment before each appointment, so the front desk knows about a lapse before the visit, not when the claim denies.
Authorizations Within Deadlines
Since January 1, 2026, Medicaid managed care plans must decide urgent prior authorization requests within 72 hours and standard requests within 7 calendar days. Kentucky law sets tighter limits for commercial plans: 24 hours for urgent requests and 5 days for non-urgent ones once the plan has the information it needs. Qualigenix tracks every open request against its deadline and follows up when a plan runs past it.
Retroactive Coverage Claims
When Kentucky Medicaid adds coverage after a visit, plans give a shorter filing window that starts from the enrollment notice. Passport, for one, allows 180 days from that notice. Qualigenix logs each retroactive notice the day it arrives and resubmits the affected visits, so self-pay balances turn into Medicaid claims before the window closes.
Medicare and Commercial Payers for Lexington Practices
CGS Administrators pays traditional Medicare Part A and Part B claims in Kentucky as the Jurisdiction 15 contractor. Fayette County also has 16 dual-eligible special needs plans for 2026, so many patients carry both a Medicare plan and Kentucky Medicaid. Qualigenix bills the Medicare plan first, then routes the balance to the correct Medicaid payer. Kentucky insurers must pay clean commercial claims within 30 days, with interest of 12% a year on late payments that rises to 21% after 60 days. Our posting team checks late commercial payments for that interest. Patient balances are the last step in the cycle. Kentucky Medicaid members can't be billed for covered services beyond any allowed copay, and federal surprise-billing rules limit what out-of-network patients owe in certain cases. Qualigenix sends patient statements only for balances the plan's remittance assigns to the patient, after secondary insurance has paid. Statements show the date of service, what each payer paid and what remains, so your front desk gets fewer billing questions at check-in.
PROVEN RCM PERFORMANCE
Results Lexington Practices Can Expect
These are company-wide results across Qualigenix client practices, not Lexington-only figures.
98%
Claim accuracy
4.8%
Denial rate
97.7%
Net collections rate
54 → 36
Days in A/R
38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$923M+
Accounts receivable recovered
1,400+
Providers set up nationally
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ Clinics6-DAY ONBOARDING
How Onboarding Works
Qualigenix takes a Lexington practice live in 6 days on average, in four steps.
01
Onboarding Call and Review
We review your billing setup, denial trends and payer mix, including your Kentucky Medicaid plan volume, and build a plan to close the gaps.
02
Software and Portal Setup
We work inside your current EMR or EHR and set up access to each payer portal. No software change is needed.
03
Account Clean-Up Work
Specialists clear open eligibility, coding, denial and posting issues so new claims start clean.
04
Live by Day Six
Your revenue cycle runs live by day 6. Payment on new claims usually lands within three weeks.
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WHY LEXINGTON PRACTICES CHOOSE QUALIGENIX
Why Lexington Practices Choose Qualigenix
One team managing the full cycle, direct operation across 133 EHRs, monthly reporting by payer, and rapid six-day onboarding.
One Team, Full Cycle
One Qualigenix team handles eligibility through payment. When a denial traces back to a missed authorization, the same team fixes the authorization step, not just the claim.
Any EHR, No Switch
We work inside your current system across 133 EMR and EHR platforms. Staff keep the screens they know.
Monthly Reporting by Payer
Each month you see collections, denials and days in A/R for every payer, including each Kentucky Medicaid plan, with every metric defined.
Six-Day Average Go-Live
Most practices go live in 6 days, and existing A/R keeps getting worked during the switch.
LEXINGTON RCM FAQS
Frequently Asked Questions
Frequently asked questions regarding Kentucky Medicaid MCO management, 2027 renewal changes, prior authorizations, and RCM onboarding in Lexington, KY.
Qualigenix runs revenue cycle management for independent practices in Lexington and across Kentucky. Compare companies on net collections rate, days in A/R and denial rate. Ask for those numbers in writing before you choose.
It includes insurance verification, prior authorizations, coding, billing, payment posting, denial management, A/R recovery and credentialing. One team runs all eight for your practice and reports results monthly by payer.
Yes. Qualigenix submits and tracks prior authorizations with Kentucky Medicaid plans, Medicare Advantage plans and commercial insurers. Each request is tracked against the plan's decision deadline.
From January 1, 2027, many Kentucky Medicaid expansion adults must report work or community engagement at renewal, and some may lose coverage. Qualigenix checks eligibility before each visit so lapses are caught before the claim goes out.
We file claims daily, work denials at the root cause and follow up on every unpaid claim. Across client practices, days in A/R dropped from 54 to 36.
Qualigenix charges a percentage of collections. The rate depends on your specialty, volume and which services you need. A revenue cycle specialist can quote after reviewing your setup.
No. Your RCM team needs to know Kentucky's Medicaid plans, CGS Medicare and your commercial payers, and it needs to work inside your EHR. Ask how a company tracks each plan's rules before you sign.