RCM workflows
Workflows built around the answer your team needs
Halcora turns defined revenue-cycle inquiries into structured results your team can review and act on. Start with one workflow, one representative batch, and a clear definition of a usable answer.
Post-service
Claim status follow-up
Turn a stalled claim into a canonical status, the inquiry details that support it, and a recommended action—without reducing the outcome to “worked.”
- Case Defined question Start with the stalled claim and the status question that needs an answer.
- Finding Normalized result Record the case state, canonical status, and relevant inquiry details.
- Decision Recommended action Keep the next supported step separate from the finding itself.
A consistent claim-status record for review
Pre-service
Eligibility verification
Confirm coverage for the date and service in question, then return the benefit details and open conditions the next person needs before care moves forward.
- Request Date and service Define the coverage question for the relevant date and service.
- Finding Coverage and benefits Return coverage, plan, and applicable benefit details when available.
- Review Open conditions Keep missing information and unresolved conditions visible before use.
A coverage result with its open conditions intact
Also supported on the same foundation
The five workflows use one operating pattern: define the inquiry, execute within the approved scope, normalize the result, and route exceptions for review.
- Claim status follow-up Post-service status and next action
- Eligibility verification Pre-service coverage and benefits
- Prior authorization Decision, requirement, and needed action
- Denial appeal Reason, record, appeal state, and recovery step
- Coordination of benefits Coverage order and unresolved correction
The first two workflows receive deeper treatment because they show both sides of the revenue cycle.
Start with the workflow you can evaluate
Bring a recurring question, an approximate monthly volume, and the result your team needs. No patient information is needed for the first conversation.