Capabilities

One platform across the whole revenue surface.

Provira started as a scrubber. It now works prevention and recovery on the same billing data — so a practice can replace a stack of single-purpose tools with one.

Capabilities are grouped by plan. Anything marked (Verify) requires a signed BAA, because it touches PHI. Anything marked (Complete) additionally requires a clearinghouse contract and payer enrollment — real setup work with real lead time, which we'll scope on the call.

Prevention & coding

Catch it before it goes out.

Deterministic scrubber. Every claim checked against the national CMS rulebook — NCCI bundling with the modifier indicator, MUE unit caps, MPFS pricing and globals. It knows which edits a modifier can clear and which it can't, the distinction that turns a "fixed" claim into a second denial.
Code Review and note audit. Covered-diagnosis and LCD checks, modifier policy, prior-auth-required flags — plus a read of the documentation against the procedure billed, so the claim leaves with the support it needs and not just the right code.
Denial-pattern learning, coder-gated. Provira works out what your payers actually require. A certified coder approves each rule before it acts — your own coder, or one NAKIRA can arrange. Nothing learned from another practice acts on your claims without your coder's approval, so you get the benefit of a wider view without ceding control of your coding.
One engine, every specialty. It adapts to each specialty's code sets, coverage rules, and note cues — orthopedics, primary care, behavioral health & IDD, DME, FQHC, chiropractic, OB/GYN, tribal / IHS, and more.

Denial work & appeals

Work what slips through, faster.

A worklist that hands you the fix. Every denied line becomes a work item carrying the payer, code, diagnosis, dollars at risk, reason code, and — because it's usually the same rule that would have caught it — the root cause and the corrected coding. Not a mystery to research.
Triage that puts the money first. Sort by recoverable dollars, deadline urgency, payer, or reason, with a timely-filing indicator so what's closest to its deadline floats to the top.
Claim it and own it. Moving an item to working locks it to you, so two people never work the same denial. Ownership sticks and transfers only by reassignment — which makes it a clean productivity signal instead of a guess.
Appeals ranked by what's actually winnable. Every appealable denial carries a deadline and predicted overturn odds — strong, even, or long shot — with the argument that has historically worked for that payer and reason, and the outcome fed back so the ranking sharpens. Nothing is sent without a person reviewing it.
Rules that keep score in dollars. Each rule carries its own record of what it changed and what those claims eventually paid, so an underperforming rule is visible and can be retired.
SLA alerts across every queue. Time targets on denial work, filing deadlines, credentialing resolution, authorization expiry, and underpayment thresholds — breaches ranked ahead of due-soon, and clicking an alert jumps to the exact item.

Before the visit · Verify and Complete

Solve it before it becomes a claim.

A payer response, turned into instructions. A raw benefits response is a wall of fields. Provira composes it into a pre-visit action plan — not "here's the response," but bill Medicare first, obtain the MRI authorization, collect $45 at check-in — with the payer order already worked out.
An authorization register that warns before it denies. What's on file, units remaining, and expiry, matched to the claim — so an exhausted or expired authorization raises a warning ahead of submission instead of a denial after it. Where a payer’s plan-level rules may differ, the flag tells you to confirm with the member’s plan rather than asserting the answer.
Good Faith Estimates, assembled. Built from your fee schedule and the verified eligibility, for your team to review and issue.

How we run verification and authorization as a service — including what a person completes rather than the software.

The full cycle · Complete

Submission through payment, in one place.

Complete is where Provira becomes the pipe, not only the brain. It submits the 837, pulls the 835 back through the clearinghouse, and matches them automatically — no file drops, no manual reconciliation. Claims move through a tracked lifecycle (Awaiting → Paid / Needs secondary / Worklist) with real payer status from a 276/277 inquiry alongside each claim's age, so "no response yet" and "denied three weeks ago" stop looking the same.

This tier needs a clearinghouse contract and payer enrollment in place, which is the piece that adds setup time.

Revenue integrity

Money you're owed but aren't collecting.

Credentialing and enrollment gaps. Provider-identifier denials are rolled into cases by provider and payer, with dollars held and days open, so a systemic enrollment problem reads as one case instead of fifty unrelated denials. A claim for a provider who isn't enrolled yet is held before it goes out.
Underpayments. Every paid line is compared against the expected allowed amount — your contracted rate, or a Medicare benchmark where we don't have the fee schedule — so paid-but-short claims surface at all. Most practices never chase this money because nothing shows it to them.

Detecting these is the platform's job. Working them is ours — the cases, the appeals, and the reprocessing requests are service work.

Built around real jobs

Access granted by an administrator, not chosen by the user.

Each job function gets its own view: owner or manager, coder, biller, credentialing specialist, patient services. A biller can't reach code review; a coder can't reach settings. Roles stack on one login for the practice where one person wears three hats — but that's always an administrator's grant, never a self-selection, and a user can never widen their own access.

Least privilege by default, with role enforcement in the product and status changes, rule promotions, and appeals written to an audit trail.

Patient balances — an add-on module.

Patient self-pay balances worked through a fixed call cadence, then a promise to pay, a payment plan, a write-off, or a hand-off to collections, with a collection-rate scoreboard. Patient name and phone are optional PHI you opt into only to place the calls; the default is de-identified. This is patient A/R rather than payer denials, so it's a module you add rather than part of the core.

Analytics

Proof the loop is working.

A denial-prevention scorecard grades every denial per payer as covered, still learning, or a gap against the live rule set — which doubles as a coder's to-do list of what to promote or mine next. Alongside it: clean-claim, first-pass, denial, and appeal-overturn rates trended over time; a value report totaling dollars actually recovered across denials, underpayments, and cleared credentialing holds; and — once the network is large enough to support one — your rates against the de-identified specialty median and top quartile.

One reporting rule we don't bend.

Realized dollars and estimated prevented dollars are reported separately and labeled. Recovered money is money you can point at. Prevented money is a well-reasoned estimate. Blending them would make a better-looking number and a worse report.

What it replaces

One place instead of five.

The work Provira consolidates is work your team already does — across CPT and ICD-10 references, a coding lookup tool, payer portal medical policies, and CMS.gov. Same research, same decisions, one screen.