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Revenue Cycle Management Services
in Richmond, VA
Qualigenix runs the full revenue cycle for Richmond practices, from the eligibility check before a Cardinal Care visit to the last posted dollar.
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How Qualigenix Serves Richmond Practices
Qualigenix revenue cycle management starts before the patient arrives. In Richmond, revenue is usually lost at four points: a Cardinal Care member seen under the wrong health plan, a missing prior authorization, a commercial claim that sits unpaid past Virginia's prompt-pay window, and a patient balance that shouldn't have been billed. Each one is fixable when one team sees the whole cycle. We work inside your current EHR and practice management system and report results by payer each month. Statewide rules are on our revenue cycle management in Virginia page. The sections below cover how the cycle runs for Richmond's Cardinal Care plans, Medicare and commercial payers.
What RCM Services Does Qualigenix Provide in Richmond?
Qualigenix handles eight connected services for Richmond practices: insurance verification, prior authorizations, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing. One team owns every step,
so a missed eligibility check or an unworked denial doesn't fall between vendors. We bill all payers and charge a percentage of collections.
RCM for Richmond's Cardinal Care Plans
Qualigenix runs the Cardinal Care revenue cycle around the health plan assigned to each member, because the plan decides the eligibility source, the authorization rules, the claim edits and the appeal path.
Eligibility Before Each Visit
DMAS tells providers to check a member's eligibility before every service, through the provider portal or the MediCall line. We check plan assignment before each appointment and again before the claim goes out, since five health plans now serve Cardinal Care and Molina members moved to Humana on July 1, 2025.
Six-Month Renewals Coming
Starting with their first renewal in 2027, Virginia's Medicaid Expansion adults renew every six months instead of every 12. More frequent renewals mean more mid-year coverage changes. Qualigenix rechecks Expansion patients more often so a lapsed member is caught at check-in, not on a denial.
Authorizations by Plan
Fee-for-service Medicaid authorizations run through Acentra Health, while each Cardinal Care plan manages its own. We secure each authorization from the right source and attach it to the claim.
Medicare and Commercial Payers for Richmond Practices
Qualigenix routes Richmond Medicare claims to Palmetto GBA, the Jurisdiction M contractor for Virginia, and to each Medicare Advantage plan your patients carry. For dual-eligible patients in aligned D-SNPs, DMAS bars providers from billing Medicare cost sharing, so we keep those amounts off patient statements. Commercial carriers regulated in Virginia must pay a clean claim within 40 days and flag defects within 30 days, and interest owed on a late claim is due with payment or within 60 days. From January 1, 2027, those carriers must also answer standard prior authorization requests within seven calendar days and expedited ones within 72 hours. We track every commercial claim and authorization against those clocks.
PROVEN RCM PERFORMANCE
Results Richmond Practices Can Expect
These are company-wide results across Qualigenix client practices, not Richmond-only figures.
98%
Claim accuracy rate
4.8%
Denial rate
97.7%
Net collections rate
54 → 36
Days in A/R
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 Richmond practice live in four steps, with a 6-day average onboarding.
01
Onboarding Call and Review
We review your billing setup, denial trends and payer mix, including your Cardinal Care plans, then build a plan.
02
Software and Portal Setup
We work inside your existing EHR, set up payer portal access and learn your specialty's routines.
03
Backlog Account Clean-Up
Specialists clear verification, coding, scrubbing, denial and posting backlogs so nothing old blocks new claims.
04
Live by Day Six
The revenue cycle runs live by day six, and legacy A/R is worked in parallel.
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WHY RICHMOND PRACTICES CHOOSE QUALIGENIX
Why Richmond Practices Choose Qualigenix
One team managing the full cycle, direct EHR integration, monthly reporting by payer, and seamless six-day onboarding.
One Team, Full Cycle
The same team handles eligibility through payment, so the cause of a denial gets fixed where it started.
Works Inside Any EHR
We work across 133 EMR and EHR platforms, so your staff keeps its system and routine.
Monthly Reports by Payer
You see collections, denials and A/R for each payer every month, with every metric defined.
Six-Day Average Onboarding
Most practices go live within a week, with legacy A/R worked alongside new claims.
RICHMOND RCM FAQS
Frequently Asked Questions
Frequently asked questions regarding Richmond Cardinal Care plans, six-month Medicaid renewals, prior authorization response times, and RCM onboarding in Richmond, VA.
No. What matters is knowing Richmond's payers: five Cardinal Care health plans, Palmetto GBA for Medicare and Virginia's commercial claim and authorization rules. Qualigenix runs all of it inside your existing system. Talk to a revenue cycle specialist to see how it would work for you.
It covers insurance verification, prior authorizations, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing, run by one team inside your EHR.
Starting with their first renewal in 2027, Virginia's Medicaid Expansion adults renew every six months. Coverage can change more often, so Qualigenix rechecks eligibility before each visit and again before each claim.
From January 1, 2027, Virginia-regulated carriers must respond within seven calendar days for standard requests and 72 hours for expedited ones. Qualigenix tracks each request to that deadline.
Qualigenix clears front-end errors before claims go out, appeals denials quickly and works open claims daily by payer and age. Across client practices, days in A/R dropped from 54 to 36.
Qualigenix charges a percentage of collections, so the fee moves with what your practice collects. A revenue cycle specialist can explain it on a short call.
Yes. Qualigenix signs a business associate agreement before any data access and works inside your existing EHR, so records stay in your system.