ENTER

AI powered revenue cycle management platform for claims, eligibility, payments, denials, coding, patient collections, contract management, reporting, and healthcare RCM automation.

About ENTER

ENTER is an end to end healthcare revenue cycle management platform designed to automate financial workflows from the electronic health record through payment collection. The platform supports eligibility verification, medical coding, claim creation and submission, payment posting, denial management, payer follow up, patient collections, contract management, and financial reporting.

ENTER combines EHR connectivity, contractAI, clearinghouse infrastructure, claimAI, paymentAI, denialAI, reporting, and an API driven architecture. Claims can be generated using EHR data, payer and contract rules, eligibility information, and claim scrubbing before being sent for adjudication. Payment workflows automatically process ERAs and EOBs, reconcile payments against contract values, and identify underpayments and denials.

The platform is also designed for integration into existing healthcare technology stacks. ENTER states that its platform is 100% API driven and provides more than 30 healthcare endpoints, with support for formats including JSON, HL7, and X12. Healthcare organizations can use ENTER alongside existing EHR, practice management, clearinghouse, payer, and custom application workflows.

Key Features

ClaimAI: Creates claims from EHR data, applies chargemaster and contract rules by payer and contract, incorporates eligibility checks, and sends claims for adjudication.
PaymentAI: Automatically posts ERA and EOB payments, reconciles service line adjudication against contract amounts, and identifies underpayments and denials.
Denial Management: Combines automated payer follow up with human and AI assisted investigation for denied and underpaid claims.
ContractAI: Digitizes and manages healthcare contracts including fee for service, value based care, employer plans, and workers compensation arrangements while supporting underpayment analysis.
EHR Integration: Connects with EHR systems to retrieve billing data and documents after encounters are locked, with custom integration support documented by ENTER.
Eligibility and Benefits: Runs real time patient eligibility verification as part of claim processing and supports coordination of benefits when patients have multiple plans.
RCM API: Provides an API driven platform with more than 30 healthcare endpoints for claims, eligibility, patient collections, and related revenue cycle functions using formats including JSON, HL7, and X12.
Claim Timeline and Reporting: Provides claim timelines containing events, payments, calls, documents, patient details, and payer information, alongside dashboards and financial reporting.
Security and Compliance: ENTER states that it is HIPAA compliant and SOC 2 Type 2 certified, encrypts data at rest and in transit, and provides role based access controls.

Pricing

ENTER RCM uses a combination of monthly platform fees, collection fees, and passthrough fees.

Small Practices: Starting at $2,500/month

Includes a single location, dedicated biller support, basic reporting, and EMR integration. The collection fee is 6%.
Large Practices: Starting at $5,000/month

Includes multiple locations, advanced business intelligence, multiple integrations, and SSO support. The collection fee is 5%.
Enterprise: Custom pricing

Includes volume based pricing, self service BI reporting, service level agreements, and a dedicated account team. Collection fees are customized.

Passthrough charges apply to services such as clearinghouse and mail usage at market rates plus a markup based on the selected plan tier.

Use Cases

Automating medical claim creation, validation, submission, and tracking
Posting payer payments and reconciling reimbursements against contracted amounts
Identifying and following up on healthcare claim denials and underpayments
Running patient eligibility verification and coordination of benefits
Managing payer contracts, fee schedules, and reimbursement rules
Connecting revenue cycle workflows with existing EHR and healthcare applications
Automating patient collections and healthcare payment workflows
Building internal healthcare financial applications using ENTER APIs

Pros & Cons

Pros:

Provides broad revenue cycle coverage across eligibility, coding, claims, payments, denials, patient collections, contracts, clearinghouse workflows, and reporting.
Offers an API driven architecture with more than 30 healthcare endpoints and support for JSON, HL7, and X12.
Automatically reconciles payments against contract values to identify potential underpayments and denials.

Cons:

Small practice platform pricing starts at $2,500 per month before applicable collection and passthrough fees.
The pricing model includes both a platform fee and a percentage based collection fee, with additional passthrough charges depending on usage.

Integrations

EHR systems, Practice Management systems, Waystar, TriZetto, Change Healthcare, clearinghouses, payer systems, JSON, HL7, X12, ENTER API, Single Sign On

FAQ

What is ENTER?

ENTER is an AI powered healthcare revenue cycle management platform that automates workflows including eligibility, coding, claims, payments, denials, patient collections, contract management, payer follow up, and financial reporting.

What does ENTER ClaimAI do?

ClaimAI creates claims using EHR data, payer and contract rules, eligibility information, clearinghouse connectivity, and claim scrubbing before sending claims for adjudication.

Does ENTER automate payment posting?

Yes. PaymentAI automatically posts ERA and EOB payments, reconciles adjudicated amounts with contract values, and identifies underpayments and denials.

Does ENTER support denial management?

Yes. ENTER's denial workflows combine programmatic payer follow up with human and AI assisted investigation of denials and underpayments.

Can ENTER integrate with an existing EHR?

Yes. ENTER documents EHR connectivity that retrieves billing data and documents, and states that it can develop custom integrations for EHR systems.

Does ENTER provide an API?

Yes. ENTER describes its platform as 100% API driven and provides access to more than 30 healthcare endpoints for areas such as claims, eligibility, and patient collections, with support for formats including JSON, HL7, and X12.

How much does ENTER RCM cost?

Small practice platform fees start at $2,500 per month and large practice fees start at $5,000 per month. Enterprise pricing is customized. Collection fees and passthrough charges also apply.