Hospital Outpatient Financial Clearance Software
Check services against payer coverage policies and generate Advance Beneficiary Notices when medical necessity isn't established.
Check services against payer coverage policies and generate Advance Beneficiary Notices when medical necessity isn't established. The workflow is configured around the documentation and payer requirements common to Hospital Outpatient care.
★★★★★5/5
★★★★★5/5
6,500+ specialty providers
Product screenshot
Hospital Outpatient workspace preview coming soon
Hospital Outpatient Financial Clearance Software for Hospital Outpatient
Built specifically for Hospital Outpatient practices, not bolted onto a multi-specialty platform, so every rule matches how your team actually gets paid.
Specialty-tuned accuracy
Coding and prior-auth logic tuned to Hospital Outpatient catches problems before claims go out.
Faster, fuller payment
Automated charge capture and posting speed up cash flow and recover dollars you're leaving on the table.
Work by exception
Automation clears the routine work so your team only touches the claims that need a human.
One system of record
Scheduling, clinical, and financial data live in one place, for a single real-time view of performance.
Deep Dive: System Capabilities & Specialized Workflows
Every outpatient encounter at a hospital, whether an infusion, imaging study, minor procedure, or clinic visit, must be coded with HCPCS/CPT codes that map to status indicators determining whether the service is separately payable, packaged into another service's APC payment, or not payable under OPPS at all. The Outpatient Code Editor applies hundreds of automated edits checking code validity, medical necessity via coverage policies, units of service limits, and code combination rules, rejecting or returning claims that fail any edit before they reach the payer's adjudication system.
Configured Automation Highlights
- Address claims rejected at the OCE stage before ever reaching the payer due to invalid code combinations, units, or status indicator conflicts.
- Address packaged services billed separately when payment status indicators dictate they should be bundled into the primary APC payment.
- Address hospital facility-side and physician professional-side claims for the same encounter creating coordination and timing conflicts.
- Address multiple procedures within the same APC family requiring correct discounting under OPPS multiple procedure payment reduction rules.
Direct Comparison
Review the module against your payer mix and current team handoffs.
Frequently Asked Questions
We Love Hearing From Our Users
Using our product doesn't just mean quality software, but also access to a community to keep you connected to your peers and to your product team.
I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.
The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.
Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.
I would recommend Unlimited Financials to other specialty practices.
We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.
We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.
I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.
The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.
Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.
I would recommend Unlimited Financials to other specialty practices.
We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.
We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.
GET STARTED
Your specialty isn't generic. Your software shouldn't be either.
Walk through your specialty's exact billing workflows with an RCM expert who already knows your codes, modifiers, and payer rules.
★★★★★5/5★★★★★5/5