PayerTruthAn HRI payer-readiness resourceRequest a billing review

Payer system mapping

Get ready to bill insurance. Stay current when payers change.

PayerTruth maps how payer organizations, products, networks, administrators, claim routes, and payment policies connect. Each operating answer stays tied to the exact scope, current source, effective date, and action still needing proof.

Bring us one payer question See how the map works

Start with your organization, state, service setting, and one payer route. Never send patient information, claim details, passwords, or portal credentials.

I need to understand the payer path

Start with PayerTruth.

Map the payer relationship, claim route, payment policy, effective date, and proof still needed.

See how the map works

I need someone to run the work

Move into HRI Managed.

Bring the current billing problem and let HRI assess the defined revenue-cycle scope.

Request a billing review

Relationship mapping

Follow the exact route from payer to operating proof.

The full system may contain many connected payer paths, but an operating answer should follow one exact route. Each connection stays tied to its source, scope, effective date, and evidence.

Illustrative relationship model · not current payer guidance

Scroll through the route

  1. 01 · Relationship

    Payer + administrator

    Identify who funds, carries risk, administers, or delegates part of the route.

    Start with one organization, state, service, and location.
  2. 02 · Coverage route

    Product + network

    Product
    Exact plan or benefit product
    Network
    Participating network or entity
    Scope
    Provider, service, setting, and location
  3. 03 · Transactions

    Claim + payment route

    Claim routeEnrollment · payer ID · destination · acknowledgments
    Payment routeAgreement · adjudication · remittance · payment
    These routes may involve different organizations and sources.
  4. 04 · Authority

    Effective-dated policy

    Source
    Official publication or agreement retained
    Dates
    Published and effective dates separated
    Applies to
    The exact route and policy scope
  5. 05 · Operation

    Action + proof

    Action
    Owner and workflow change named
    Evidence
    Completion and source retained
    Review
    Last checked and next review recorded

Policy overlay

See which claim and payment policies attach to the route.

  • 01Participation + network
  • 02Eligibility + authorization
  • 03Documentation + coding
  • 04Submission + timely filing
  • 05Claim edits + payment methodology
  • 06Remittance + denials + appeals

Keeping the map current

When a payer changes a rule, update the route.

A notice becomes useful only after the affected relationship, policy, date, action, and evidence are connected.

  1. 01SourceMonitor the official publication or agreement.
  2. 02RouteFind every affected product, network, service, and location.
  3. 03PolicyCompare the prior and current claim or payment rule.
  4. 04OperateName the owner, change, proof, and next review.
Lines show operating dependency, not corporate ownership. A real route must be confirmed from current source evidence for its exact product, network, provider, service, location, and effective date.
Behavioral-health team members bringing their hands together
Health Revenue IntelligenceBuilt and led by behavioral-health operators
Christopher RyanPartner · Revenue Intelligence Systems
Peter BuschPartner · Operations & Provider Relationships
Meet the HRI operators

PayerTruth + HRI Managed

Map the route. Then let HRI run the defined operation.

PayerTruth maps the relationships, policy sources, dates, and unresolved questions. HRI can then assess the fit and take on the defined billing and revenue-cycle work under a separate engagement.

PayerTruthMaps relationships, claim routes, policy sources, dates, and open questions.

HRI ManagedRuns defined billing operations, payer follow-up, denials, appeals, and underpayment review.

Request a billing review Explore HRI services

Straight answers

What PayerTruth is—and what it is not.

Will PayerTruth tell me I am in-network?

PayerTruth helps organize what must be verified. Network participation requires current payer and agreement evidence for your exact scope.

Does payer readiness mean a claim will be paid?

No. Readiness, claim submission, transaction acceptance, adjudication, and payment are separate stages.

Does PayerTruth replace payer manuals, agreements, or plan documents?

No. PayerTruth connects an operating route to those current sources; it does not replace them. Conflicting or unclear requirements still need direct verification with the applicable authority.

When does HRI step in?

When the initial payer path and ongoing billing needs are clear, HRI can assess fit and define a separate managed billing and revenue-cycle engagement.

Ready to move?

Turn the map into operating work.

Tell HRI what is getting in the way—one payer, one route, or one policy question. If the organization appears to fit, Chris or Pete will follow up about the right next step.

Request a billing review Meet Christopher and Peter No PHI is needed. Leave patient information, claim details, and credentials out.