Company
NAKIRA Solutions builds Provira. We came at this from the billing side of the problem, not the software side — which is why the product is built around preventing the denial instead of reporting on it.
Mission
Make the administrative side of medicine cost less and work better — streamlining billing, recovering what practices are owed, and preventing denials before they happen. We pair hands-on revenue-cycle expertise with our own technology that learns each practice's payers and adapts to how they actually adjudicate, so providers can get back to patient care.
Who built it
Clarence has spent over 20 years directing revenue cycle operations, most recently for an orthopaedic specialty practice. Before that: billing, collections, and A/R across hospital systems, physician groups, DME suppliers, behavioral health and human services organizations, FQHCs, dental programs, and home health. Portfolios up to $400 million. Teams up to 32 people. Which is also why our specialty coverage looks the way it does — those are the places the work actually happened.
The numbers he's held: denial rates of 5 to 8 percent. Clean-claim rates of 95 to 98 percent. A/R over 90 days cut from $19 million to $8 million at one organization.
“I've spent my career helping organizations find the true root of their denials — and then strengthen their back end, and ultimately their front end, so those denials stop coming back.”
That's the whole idea, and it's why Provira works the way it does. A reason code tells you what the payer rejected. It doesn't tell you why your process let the claim through. The cause is almost always upstream — in how the patient was registered, whether coverage was checked, whether the authorization was on file, whether the provider was enrolled, whether the note supported the code.
Every tool he could buy stopped at the reason code. The dashboards were never the problem — he'd built plenty himself, writing the SQL and standing up the KPI frameworks. The problem is that a report about a denial arrives after the money is already late, and it points at the claim instead of the process. So he built the thing that finds the actual cause, then closes the gap at the front desk.
BS, Healthcare Management. Based in Middletown, Delaware.
What we believe
What NAKIRA does
NAKIRA is a revenue cycle organization; Provira is the technology we built to run it. Most billing companies operate your revenue cycle on software they license from someone else, which means their service can only be as good as a tool built for everyone. We build ours, around the practices we serve.
Every line above runs on the same claim and remittance data, through the same engine. A denial worked in the service model becomes a rule that, once approved, prevents the next one. A credentialing gap we close stops the claims that would have denied next month.
A billing service running licensed software can work your denials well. It can't turn what it learned this month into something that prevents them next month. That's the part we built — and we'd rather be measured on it than described in adjectives, so we'll agree the numbers we're accountable for up front and report against them.
The certified coder
By default, your own credentialed coder — they know your payers, your providers, and your documentation, so no one is better placed to judge whether a learned pattern is real. If you'd rather not staff it, we can arrange that. Either way, nothing acts on your claims that a credentialed person hasn't approved, and that includes patterns learned from the network.
Data stewardship
PHI stays protected under HIPAA and a signed BAA. Anything we learn across our network is de-identified and payer-level only — never a patient, never a claim.
Delaware · Product: Provira · nakirasolutions.com · info@nakirasolutions.com
Whether you want the software, the service, or just an honest read on where your revenue is leaking.
