RCM Workflow
Billing Automation Map
ⓘ

System

EMR
Clearinghouse
Billing / PM
External report

ProCode status

live in-build planned
data ok partial blocking

This is your billing workflow one-sheeter, made interactive. Node colors = system (EMR / Clearinghouse / Billing-PM / External Report); the tag above each node = owner role. Click a node to zoom into its process flow, checklist, KB, ProCode touchpoint, and EMR/PM status. Checklist state saves locally.

Coverage Tracker — appointments + billing data points

From the EMR-Data-Point spec (updated 2026-06-23): Appointment RPA — 44 data points, live on 8 EHRs (70/127 clients) — plus the billing build spec — 85 net-new data points across Charges / Payments / Adjustments / Encounter / Add'l / Clearinghouse (14 PM, 115 clients, 0 built today). By data point = per-category coverage; By system = per-EMR checklist (tick as built). Two denominators (127 appt / 115 billing) are never summed.

OpenPM 33NexTech 25ModMed 16Tebra 13PracticePlus 8Symplast 7AdvancedMD 3EZDerm 2IntakeQ 2DrChrono 2LightningMD 1eCW 1Remedly 1PatientNow 1Meditab 0 no-scraper
Workflow node / data needOpenPMNexTechModMedTebraPract+SymplAdvMDEZDermIntakeQDrChrLightneCWRemedPatNowMedi
Coding (ProCode AI)✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
ERA Retrieval / posting (835)✓✓✓✓✓✓✓✓tbd✓tbd✓tbdtbd⛔
Claim Submission / CH Rejection (277)EtacTriZTriZTriZTriZTriZTriZTriZTriZTriZTriZTriZTriZTriZ⛔
Denial Management (denial flag)⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔
Payment posting (adjustment level)⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔
Apply Secondary Balance (2nd payer)⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔⛔
Charge Entry near-zero fieldstbdtbdtbdtbdtbdtbdtbdtbdtbdtbdtbdtbdtbdtbd⛔

Denial / adjustment / secondary-payer rows are ⛔ across all systems because they're net-new (0 captured today) — a build, not a per-system gap. Clearinghouse: OpenPM→Etactics, all others→TriZetto (84% via 2 integrations).

Asana build status — ProCode Dev

Live tickets from the Procode Asana, mapped into our workflow categories (Asana tasks = lines; categories = our system). State from the dev pipeline section: ⛔ HOLD · ◐ in-progress · ✓ Production.

Product Operating Framework

Product KPI board. Modules (ProCode AI · ProRevenue · Provider App) each carry a headline KPI and hold capabilities — each capability carries its own KPI and a dashboard over time from launch, rolling up its Asana tickets + build stage. KPI Board = live monitoring · Launch = deploy / training track · Timeline = the schedule · Tickets = the underlying work.

COMMUNICATE

Every ship gets one announcement

1–2 announcements per shipped feature — same format, same channel, every time: what it is, who it affects, and what action (if any) is needed.
Owner James (Teams auto-notify) / John (email + video for larger deploys)
Artifact Running log: feature → ship date → announced?
"What shipped this week — and was it announced?"
DEPLOY

Done = trained and in active use

The stage most likely to quietly fail — shipped and adopted get conflated. "Done" isn't code shipped; it's the relevant ops team trained and using it.
Owner John / Maria / Felix
Artifact A one-line status per feature from the ops lead.
"Is it actually being used by who it's for?"
MEASURE

Did it do what we said it would?

Every feature built to drive Revenue, EBITDA, Revenue/head, or Client retention gets revisited 4–6 weeks post-launch against that same metric.
Owner Jeff / James / John / Alex
Artifact Don't measure everything every week — measure something every week.
"Did it do what we said it would do?"

The new weekly product call — 3 additions, ~12 min

  1. Roadmap / prioritization (as today)
  2. Development status (as today)
  3. Shipped this week — communicate check · 10 min
  4. Adoption check — 1–2 features from last month · 10 min
  5. Impact check — 1–2 features from 4–6 weeks ago vs. original metric · 10 min
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