maxRTE

maxRTE is a specialized healthcare revenue cycle management (RCM) platform designed to automate and optimize the front-end and mid-cycle processes of insurance eligibility and discovery. The software's primary mission is to eliminate uncompensated care by identifying billable insurance coverage for patients who are initially classified as self-pay. By utilizing a proprietary algorithm, maxRTE searches through hundreds of commercial, government (Medicare/Medicaid/Tricare), and exchange-based payer databases to find active coverage that registration staff or patients might have overlooked. This process typically identifies billable coverage for up to 25% of self-pay accounts, directly impacting a provider's bottom line. Beyond discovery, the platform provides real-time eligibility (RTE) verification at the point of registration. With a single click, staff can retrieve detailed benefit data, including co-pays, deductibles, and coinsurance amounts, which enhances financial transparency for the patient and ensures accurate billing from the start. The system is built to integrate seamlessly with major Electronic Health Record (EHR) systems like Epic and athenahealth, allowing for automated batch processing or real-time API-driven checks. By shifting the focus to accurate front-end verification, maxRTE helps healthcare organizations reduce claim denials, accelerate cash flow, and lower the costs associated with manual collection efforts.

The primary competitive advantage of maxRTE lies in its disruptive pricing model and its superior 'hit rate' for insurance discovery. Most RCM vendors operate on a contingency basis, taking a percentage of the revenue they help recover, or they charge per-transaction fees that make high-volume discovery prohibitively expensive. maxRTE utilizes a flat monthly fee for unlimited transactions and unlimited users. This allows healthcare organizations to run discovery on 100% of their self-pay and balance-after-insurance accounts without fear of rising costs, leading to a much higher total ROI—often exceeding 50x as seen in various case studies. Technologically, maxRTE's proprietary algorithm is specifically tuned to detect government coverage (Medicare, Medicaid, and Tricare) and COBRA benefits that standard eligibility tools frequently miss. It supports 'retro-eligibility' checks, allowing providers to look back at past services to find coverage that was activated after the date of service, which is a critical feature for capturing Medicaid reimbursements. Additionally, maxRTE's integration flexibility is a major differentiator; it offers native integration with Epic and athenahealth, but also supports HL7, FHIR, X12, and SFTP batch transfers for organizations with legacy systems. This 'vendor-agnostic' approach, combined with a commitment to HIPAA compliance and SOC 2 Type 2 security, makes it a more accessible and secure choice than many suite-heavy RCM platforms that require total ecosystem buy-in.

• SMB
• Mid-Market
• Enterprise