The operating layer for every payer relationship.
Know what each payer expects, where you stand, and what to do next. Across care, revenue, and credentials.
“Circle has been such a huge part of our clinical program. Without it, keeping everything running smoothly would be much more challenging.”
- Records processed
- 2M+
- Records processed
- Chart review coverage
- 100%
- Chart review coverage
- Payer reviews cleared per reviewer day
- 3x
- Payer reviews cleared per reviewer day
- Less time to a compliant signed note
- 70%
- Less time to a compliant signed note
A system forthe relationship betweencare and payment.
EMR
Manages the patient record.
Stays the clinical record.
RCM
Manages the transaction.
Claims, remittance, and collections keep running as they do today.
Manages the payer relationship.
Payer criteria, authorizations, credentials, and billing rules in one system.
Circle works alongside the EMR and reads the systems already in place.
What Circle does. Payer intelligence first, then the work it guides.
Each payer sets requirements for the record, the authorization, the claim, and the people delivering care. Circle keeps that context together, shows what each payer expects, and points teams to the next action.
Where is revenue at risk with each payer, and are you being paid adequately for the care delivered?
Leaders see each payer in one view: where revenue leaks, whether reimbursement reflects the care delivered in network and out, and what the record proves before contract renewals.
Payer standing brief
- Review needed
In-network
Paid below the contracted fee schedule for this code
- Review needed
Out-of-network
Reimbursement below regional benchmarks for this service
- Review needed
Revenue risk
Auth gaps and unbilled units caught before billing
- Complete
Chart coverage
Every chart reviewed with cited clinical proof
Different payment models. The same need to prove the work.
Fee-for-service
Encounters and procedure codes
Documentation that supports each billed code and the payer's criteria before the claim goes out.
Per diem and case rates
Authorized days
Medical necessity for the current level of care, shown in every concurrent review before the window closes.
Hourly and unit-based care
Authorized hours and units
Services delivered matched to what was authorized and documented, session by session.
Value-based and risk contracts
Quality and outcomes
Clinical progress shown in the record, defensible when contracts tie payment to care quality.
Public programs and grants
Program requirements
Each encounter traced to state rulebooks and program requirements, ready when oversight asks.
