Rheumatology RCM, built around the biologic
Biologic prior authorization, joint assessment documentation, and infusion drug-waste tracking for rheumatology practices.
Why rheumatology billing is different
A rheumatology claim usually hinges on a high-cost biologic and the disease-activity documentation that proves medical necessity for it. When joint counts, lab markers, and drug administration details don't align in the billing record, payers deny coverage for medications that can run thousands of dollars a dose.
What generic software misses
- Prior authorizations expire mid-course, and renewal deadlines get tracked by spreadsheet, if at all.
- Joint-count assessments like DAS28 or CDAI go undocumented in the billing record, weakening medical necessity.
- Copay card and foundation assistance balances are matched to claims by hand.
- Ultrasound-guided joint injections get billed without the imaging guidance code paired correctly.
What the platform does about it
Biologic pre-clearance matrix
Payer step-therapy and formulary requirements are checked automatically before a clearance request goes out.
Renewal tracking across cycles
Authorization windows are monitored against the treatment plan, with alerts well before expiration.
Disease score documentation
DAS28, CDAI, SDAI, and RAPID3 inputs are bound directly to the billing claim.
Copay assistance matching
Manufacturer and foundation assistance balances apply to the patient ledger automatically.
Generic software vs. Unlimited Financials
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