TrueRCM is the billing system for vaccination programs in skilled nursing, long-term care and assisted living. Nurses record the shot at the bedside; TrueRCM builds the visit, picks the right product and administration codes for Medicare, Medicare Advantage, commercial and Medicaid, prices it off the CMS fee schedule, blocks the claims that shouldn't go out, and posts the money when it comes back.
Built for mobile vaccination clinics and medical-director groups serving SNF / LTC / ALF residents · Flu, pneumococcal, COVID-19, hepatitis B and the full ACIP catalog
Vaccine programs lose money in the gaps — the wrong admin code, a missing NDC, a dose given during a Part A stay, a lot nobody tracked. TrueRCM runs the whole program in one place so none of those gaps exist.
Pick the facility, pick the resident, pick the vaccine and lot. Site, route, dose, VIS date, consent and screening are captured in one tap on a tablet — by the nurse or technician who gave the shot.
Medicare and Medicare Advantage get G0008 / G0009 / G0010 and 90480; commercial and Medicaid get 90471 / 90472; per-payer overrides when a plan's policy differs. NDC, units and Z23 land on every product line, in-home add-ons only where they belong.
Medicare allowed amounts for every flu, pneumococcal, COVID-19 and hepatitis B product (95% AWP) plus administration rates for all 109 CMS localities. Refreshed from the official CMS files each season and quarter; your contracted fee schedules always win.
Stops the claims that get denied: resident in a Part A SNF stay, Part D vaccine on a Part B claim, admin code without product, wrong admin family for the payer, missing NDC, NCCI one-family-per-day, expired lot, duplicate in season.
Receive stock by NDC, lot and expiration per client or facility. Every administration decrements on hand; expiring and exhausted lots surface before a clinic day, and the lot's NDC flows straight onto the claim.
Nurses administer, the group's medical director bills. Facility types drive place of service (SNF 31, NF 32, ALF 13), Medicare locality and roster-billing flags — configured once per client.
837P claims with NDC segments and idempotent submission through Claim.MD; 835 remits auto-post line by line, unmatched lines go to a review queue, reversals and refunds are first-class.
CARC/RARC-routed worklist ranked by recoverable dollars, one-click corrections and resubmissions, and AI-drafted appeals that are citation-verified and human-attested before anything is sent.
Doses given, billed and paid by facility, payer and vaccine; unbilled and held visits; Part A holds; registry reporting status; A/R aging and KPI alerts — exportable and schedulable.
Five stops from the med cart to the remittance.
The clinic-day screen lists the facility's residents. The nurse picks the resident, the vaccine and the lot; consent, VIS, site and route are one tap each. Part A-stay residents are flagged before the needle, not after the denial.
Each administration becomes the day's visit under the medical director with a product line (CPT + NDC + units + Z23) and an administration line chosen for the payer — then priced from your fee schedule or the CMS allowance.
The scrubber knows vaccine billing. It holds what would be denied and explains why, then the clean claims go out on idempotent 837P with NDC segments.
835 remits auto-post to the matched claim; what doesn't match goes to a queue, not a black hole. Denials route by CARC/RARC and are ranked by dollars, with corrections and appeals one click away.
Inventory by lot with expiry warnings, the immunization log with billing state, registry reporting status, and the financial reports every program needs — exportable and schedulable.
Vaccine billing is rules, not guesswork — so the rules are deterministic and audited. AI is used where prose is needed, never where facts are.
Admin-code selection, pricing and every scrubber rule are plain, documented logic with a cited source (CMS Claims Processing Manual, NCCI, payer policy). The same inputs always produce the same claim, and the reason for every hold is shown in words.
When a payer denies a vaccine claim, AI writes the appeal prose under a signed BAA with zero data retention. Codes, lots, dates and amounts are pulled from your records — never generated — and a citation verifier blocks any mismatch before a human attests and sends.
"Create claims for yesterday's clinic at Oakridge." "How many doses did we bill Humana in October?" Velox parses trusted instructions only, re-checks your permissions on every action, and stops at an approval gate before anything irreversible.
HIPAA-aligned controls enforced in the database, not just the UI.
Tenant isolation enforced by PostgreSQL RLS — the app connects as a non-superuser role that physically cannot cross tenants.
A billing group manages many medical-director clients, each with their own facilities, stock and providers, scoped inside one tenant.
TOTP, email, or SMS with recovery codes. Secrets stored encrypted; setup enforced at first login.
Immunizer, biller and admin roles; every route and every copilot action re-checks permissions.
Every administration, override, attestation, approval and admin change lands in an append-only, hash-chained audit log.
The only live AI vendor operates under a signed BAA with zero data retention, and prompts carry minimum-necessary facts.
Clinic day, inventory and the immunization log — tablet-friendly, nothing else in the way.
Claims, ERA, denials, appeals, statements, reports and the copilot for every facility and payer.
The billing provider sees the schedule, the residents vaccinated under their NPI, and their profile.
Residents or representatives view immunizations, visits, statements and balances in one place.
Guided walkthroughs of every workflow — from receiving stock and running a clinic day to posting remits and working denials — that play like videos, captioned, with progress tracking. Free and public, so staff can train before their first login.
▶ Open the Training CenterBring one clinic day's roster and one month of remits — we'll show you which doses never got billed, which were coded wrong, and how TrueRCM closes the gaps.