Every payer an easy yes.
Get paid for the care you deliver with one system that puts admissions, clinical, and revenue on each payer's rules, proving medical necessity at every step from bedside to balance sheet.
The payer relationship system for healthcare operators. Works with your EMR.
“Having oversight across every client is a game-changer, especially as our census grows.”
Chloe PetruzzoChief Strategy Officer, Moving Mountains Recovery- Authorized days per review, national RCM partner
- 2×
- Authorized days per review, national RCM partner
- Treatment plan timeliness as census grows, Moving Mountains Recovery
- 93%
- Treatment plan timeliness as census grows, Moving Mountains Recovery
- Less time per chart, verified for medical necessity, Monument Recovery
- Over 65%
- Less time per chart, verified for medical necessity, Monument Recovery
- Insurance plan rulebooks processed across payers
- 1,000+
- Insurance plan rulebooks processed across payers
- Records processed across Circle customers
- 2M+
- Records processed across Circle customers
Your EMR holds the record.Your RCM submits the claim.Circle manages the payer relationship.
EMR
Holds the record
The legal clinical record: charts, notes, assessments, and treatment plans.
Clinical systems
- And more
RCM
Submits the claim
Moves the claim to the payer and the payment back to the books.
Billing flow
- Claim submission
- Clearinghouse
- Payment posting
- Collections
Manages the payer relationship
Knows exactly what each payer expects and acts before reimbursement is at risk.
Payers
- Dozens more
Accreditation
- And more
Circle works alongside your EMR and RCM.
Start by understanding what each payer expects, then take the steps to meet those requirements.
Each payer has its own rules for records, authorizations, claims, and clinicians. Circle brings these rules together, shows your chart status, and guides your team on next steps.
See where revenue is at risk with every payer, and whether you're paid fairly for the care you deliver.
Leaders can see all payers in one place: where revenue is leaking, if reimbursement matches the care delivered both in and out of network, and what the records show before contract renewals.
Payer standing brief
- Paid vs. contracted rateReview needed
- Out-of-network allowed amountReview needed
- Authorized vs. billed unitsComplete
Measured results from customers.
Each result starts with understanding what the payer expects. Then the team takes the next step to meet it.
Randolph, NJ
- Payer expects
- Treatment plans kept current as census grows
- Next step
- Gaps flagged in real time and turned into staff training
Result
93%
Treatment plan timeliness as census grows
“We can identify gaps in real time and turn them into opportunities to train staff, so the same issues don’t keep coming up.”
Read the storyChloe PetruzzoChief Strategy Officer
Mesa, AZ
- Payer expects
- Medical necessity shown across every ASAM and LOCUS dimension
- Next step
- Each chart checked against those criteria before signature
Result
Over 65%
Less time per chart, with every ASAM and LOCUS dimension checked for medical necessity before signature
“You can’t argue with Circle’s validated record. It either meets medical necessity or it doesn’t.”
Read the story
Bradley WagnerClinical Director
Virtual provider
- Payer expects
- Complete notes for every session, finished on time
- Next step
- Notes drafted from dictation and reviewed by the clinician before signing
Result
Over 50%
Documentation time returned to Third Space clinicians
“The dictation tool has saved me an incredible amount of time and energy. I can get through my notes so much faster.”
Stephanie NewmanLAC
Circle is built for every team that answers to a payer.
Every care setting has different payer rules. Find yours and see what Circle checks for you.
Behavioral and Specialty Care
4 settingsLevels of care, medical necessity, and accreditation on every chart.
Community and Post-Acute Care
3 settingsVisits, hours, and eligibility documented the way each program expects.
Enterprise and Revenue Operations
3 settingsPayer rules held consistent across sites, clients, and public programs.
No matter how you get paid, your payer needs proof.
Fee-for-service
Documentation supports each billed code and meets the payer's criteria before you send the claim.
Paid onEncounters and procedure codesPer diem and case rates
Medical necessity for the current level of care is shown in every concurrent review before the review window closes.
Paid onAuthorized daysHourly and unit-based care
Services delivered are matched to what was authorized and documented, session by session.
Paid onAuthorized hours and unitsValue-based and risk contracts
Clinical progress is shown in the record, making it defensible when contracts link payment to care quality.
Paid onQuality and outcomesPublic programs and grants
Each encounter is linked to state rulebooks and program requirements, so you are ready when oversight asks.
Paid onProgram requirements
Commonly asked questions.
Something else on your mind? Email hello@circlehealth.co.
See what each payer expects. And where every chart stands today.
In 30 minutes, we'll show you where your charts stand.
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