Your Biller Shouldn't Own a Percentage of Your Revenue

When claims moved on paper and payer rules lived in binders, buying the whole capability as a service, priced on outcomes, was rational. RCM companies did genuinely hard work.

But the plumbing underneath has changed. Insurance companies now expose real electronic rails; clearinghouse networks have matured into modern APIs; a claim today is a structured data object, validated by software in milliseconds, routed to any of thousands of payers, and acknowledged the same day, with the remittance flowing back as data. Work that once needed a room of specialists can now be done by a small team with good technology and AI doing the remembering.

The percentage model isn't wrong — it's being phased out by better infrastructure. And that's an enormous savings opportunity for clinics. Moxcares makes it practical by putting the whole revenue cycle — eligibility, coding, scrubbing, claims and remits — on one platform, on one spine.

Take a concrete practice: ten providers, a normal mix of commercial payers and Medicare. To keep the arithmetic transparent, assume each provider generates $60,000/month in collections and about 330 claims/month — so $600,000/month collected and roughly 3,300 claims/month practice-wide.

The honest version includes staff: software doesn't answer phones. Keep two full-time billers at a loaded $65,000 each to work the queue inside Moxcares and the all-in cost is about $150,000/year — still roughly a third of the RCM bill, with every dollar of the difference staying yours.

And one thing the table can't show: Moxcares never touches your insurance money. Payers pay your bank directly; what flows through the platform is the data about the payment. We make your money arrive explained — not arrive through us.

The industry-wide initial denial rate reached 11.8% in 2024, and 41% of providers now report denial rates above 10% (Experian State of Claims data). Each denial costs real money to fight — MGMA pegs average rework at $25 per claim, with formal appeals averaging $118 (Merits Research) — and roughly 65% of denied claims are never reworked at all, becoming permanent write-offs.

Yet survey data reported by MGMA suggests 86% of denials are potentially avoidable, with registration and eligibility errors alone causing nearly 27% — the single largest driver (MedPrecision's sourced summary).

Read those together and the conclusion writes itself: the leverage isn't in heroically fighting denials after the fact — it's in not generating the denial. That's a technology problem, and it's exactly what modern rails plus AI are good at.

When we selected the clearinghouse under Moxcares, our research compared Stedi against the other leading products in the space, and Stedi stood apart on the things that define a great clearinghouse. It is genuinely API-first: claims, eligibility, claim status and electronic remittances are clean JSON endpoints that translate to HIPAA-compliant X12 behind the scenes, with a free sandbox and documentation good enough that our engineers rarely needed support (Stedi healthcare APIs).

Its coverage is complete — 3,500+ payers, spanning virtually all U.S. medical and dental payers, Medicare and state Medicaid programs — and the full claim lifecycle is native: professional, institutional and dental submission with automated edits, real-time acknowledgments and status checks, ERAs delivered as data, and even paper CMS-1500s printed and mailed for the payers that still want them (stedi.com).

It publishes a 99.9% reliability SLA, runs on dedicated infrastructure per customer, and carries a detail that says a lot about the company's posture: failed API calls aren't billable (Stedi docs). In a sector where recent history showed what happens when the industry concentrates on one legacy network, Stedi's modern, transparent, engineering-led approach is simply how this infrastructure should work — and it's the promise we wanted under our clinics. You can see the rest of what we connect to on the integrations page.

Here's what changes day to day for your staff. Every Moxcares claim passes a deterministic scrub before it can be submitted — the checks a veteran biller runs in her head, run by software, every time: diagnosis pointers present, ICD codes billable and current, code-versus-age-and-sex sanity, date logic against DOB and today, NPI/EIN/taxonomy/place-of-service complete, duplicates caught. Hard failures block; soft issues warn. The claim that would have bounced back in nine days gets fixed in ninety seconds instead.

Coding help arrives as cited AI suggestions, never silent automation — each proposed CPT code carries its rationale, requires a human click to accept, and can only come from the legal set for that visit.

And eligibility runs before the visit, not after the denial — one-click real-time verification at check-in catches the expired plan and the wrong member ID; one primary-care case study reported a 20% drop in eligibility-related denials within 90 days of adding exactly that step (Bristol HCS).

The time math, kept deliberately conservative: if structured capture and code suggestions save even 5 minutes per claim, our ten-provider practice gets back about 275 staff-hours a month — more than 1.5 full-time billers' worth of time. And moving from the 11.8% industry denial rate toward the under-5% range well-run practices achieve means ~225 fewer denials a month: $7,000–$12,000/month in rework labor avoided at published per-denial costs, before counting the claims that would otherwise have joined the never-resubmitted pile. Treat these as directional; run your own numbers — we'll happily walk you through the model against your actual volume.

The claims pipe has become modern infrastructure — fast, electronic, reliable — and Stedi is the best version of it we found. What clinics have long paid a percentage of collections for was largely the labor of compensating for older tools. With better rails, smart scrubbing and AI assistance on one platform, a small team collects what a large one used to — and the savings stay in the practice.

Your revenue is yours; the software to collect it should have a price tag, not a stake. Our numbers are published on the pricing page, and the patient-side of the ledger — cards on file, tap-to-pay and balance follow-ups — lives on the payments page.

Moxcares is a HIPAA-compliant platform for multi-location clinics — scheduling, AI intake, charting, payments, eligibility and claims on one system. Claims run on Stedi's clearinghouse rails; money runs from payers directly to your bank. Industry figures reflect published data as of mid-2026 (Experian, MGMA, CAQH, Premier Inc.); illustrative practice math uses stated assumptions — substitute your own volumes.