NAKIRA Solutions works your revenue cycle end to end — eligibility and authorization through denials, appeals, and underpayment recovery. We do it on Provira, the claim-integrity platform we built ourselves, because the tools we could buy only ever told us a claim was denied.
Two decades of revenue-cycle leadership · HIPAA-aware · coder-reviewed
The thesis
Most revenue-cycle work stops at the symptom. You get a reason code, you rework the claim, you move on — and the same denial comes back next month from the same payer for the same reason. The cause is almost never in the claim. It's upstream: registration, eligibility, authorization, credentialing, documentation, coding.
So we work backward from the remittance to find the actual root, then fix it forward at intake. Back end first, because that's where the evidence is. Front end ultimately, because that's where the fix belongs.
Most companies work your denials. We work the reason you have them.
What we do
Take the pieces you need or hand us the whole thing. Either way it runs on the same platform and the same data, so far less falls between vendors.
Eligibility and benefits verification, coordination of benefits, prior-authorization management with units and expiry tracked, and No Surprises Act patient estimates. Every check comes back as a pre-visit action plan: who to bill first, what authorization to get, what to collect at check-in.
Medical billing and coding, charge capture, documentation review, and claim integrity checked against the national coding rules before submission — bundling, unit caps, modifiers, covered diagnoses, and prior-auth flags.
Denial management with the root cause and the corrected coding attached, an appeals queue ranked by deadline and by the odds of winning, A/R follow-up and aging, underpayment recovery, and credentialing worked to resolution.
Why our service is different
Most revenue-cycle firms run your account on a platform they license — which means their service can only be as good as a tool built for everyone. Provira was built for this work specifically, by the people doing it, and it learns from your payers as it goes.
The loop
Every claim checked against the national coding rules — NCCI bundling, MUE unit limits, MPFS pricing — before it's ever submitted.
Provira studies what your payers actually deny, and works out the requirements a national scrubber doesn't carry.
A certified coder — yours, by default — reviews each learned rule and decides whether it acts on your claims.
Promoted rules feed back into the scrubber, so the next matching claim is caught before it can deny.
Anything that still denies becomes a work item with the cause, the correction, and a drafted appeal.
Prevention first — not just cleanup after the fact.
What that's worth
The same batch, three months running. Every claim that denies teaches a rule; every promoted rule stops the next one that matches. The work doesn't get faster because anyone is trying harder.
Each one reviewed and promoted by a certified coder before it was allowed to act. Nothing on this list changed a claim on its own.
The three coding rules named here are public CMS content — National Correct Coding Initiative procedure-to-procedure edits, Medically Unlikely Edits, and CMS guidance on timed units. Prior-authorization requirements vary by payer and by plan, so Provira treats them as a prompt to verify rather than a final answer.
Breadth
Denial prevention. Denial management and appeals. Prior authorization and eligibility. Underpayment recovery. Credentialing. Claim tracking and A/R. Analytics, with peer benchmarking arriving as the network grows.
Most practices buy these separately, or don't buy them at all and absorb the loss. Here they run on one set of claim and remittance data — which is also why what we learn in one place improves the others.
Who we serve
Each with the coding depth it actually needs — from surgical bundling to therapy visit caps to dispensed DME.
And more — the engine adapts to a specialty's code sets, coverage rules, and note cues rather than being written for one.
It's also built around real jobs: billers, coders, practice administrators, and credentialing specialists each get their own view, with access granted by an administrator rather than chosen by the user.
Plans
Clean-claim scrubbing and denial intelligence. No PHI, no BAA required — the fastest way to start.
Adds eligibility, coordination of benefits, and prior-authorization checks under a signed BAA.
The full revenue cycle: claim submission, ERA matching, and the entire denial lifecycle in one place.
Scrub is available now as a pilot, on de-identified data. Verify and Complete onboard as your BAA and clearinghouse connectivity are in place.
Security
PHI is handled server-side and never touches the browser, and it's used only for the one task that needs it. Our learning network shares only de-identified, payer-level statistics — never patient data or claim detail. Data is encrypted in transit and at rest, access is least-privilege and administrator-granted, and privileged actions are logged.
SOC 2 — in progress, not certifiedWe're pre-PHI today: the platform runs on synthetic and de-identified data, and we won't accept a practice's PHI until our Business Associate Agreements and production security controls are fully in place. Ask for the current checklist.
Who built it
Clarence Brown directed revenue cycle operations for hospital systems, physician groups, DME suppliers, behavioral health organizations, FQHCs, and orthopaedic practices before building Provira — portfolios up to $400 million, denial rates held at 5 to 8 percent, A/R over 90 days cut from $19 million to $8 million.
“Find the true root of a denial, and you can stop it coming back.”
Book a 20-minute call, or send a de-identified denial report and we'll tell you what's driving your denials and what it costs you monthly — no PHI required.
