Executive Summary
Strategic thesis + headline differentiators
Resources
Take it with you.
Download the executive brief, look up an acronym, or get in touch. Everything on this site traces back to the 14-document executive overview dossier — the brief consolidates it into a single PDF.
Executive brief
The full dossier as a single PDF.
Generated from the 14-document executive overview. Includes every diagram, every claim, and every source citation rendered on this site. The print stylesheet preserves layout and dark/light contrast.
MedSuite RCM Platform — Executive Brief
14 sections · capability deep-dives + diagrams + comparison tables · generated from this site via Playwright at deploy time.
Glossary
Acronyms + canonical terms.
Behavioural-health Medicaid RCM has a lot of three-letter words. This list covers the ones used on this site; the source dossier has a more exhaustive set.
- Canonical model
- The platform's single internal vocabulary — ServiceEvent, ChargeItem, Claim, Remittance, LedgerEntry, and their relations. Format adapters translate at the edge; canonical types are the lingua franca of the rest of the codebase.
- CARC
- Claim Adjustment Reason Code. CAQH CORE-maintained code that explains a payer adjustment on an 835 remittance.
- CCBHC
- Certified Community Behavioral Health Clinic. SAMHSA-designated provider type; on the platform an extension via canonical_program + state-scoped YAML.
- Companion guide
- A trading partner's documented overrides to the X12 standard — segment-by-segment requirements that go beyond what the standard prescribes.
- COB
- Coordination of Benefits. The cascade that determines which payer is responsible for which portion of a member's claim.
- DEK
- Data Encryption Key. Per-tenant encryption key for PHI; rotated quarterly; sealed in Azure Key Vault.
- EVV
- Electronic Visit Verification. State-mandated GPS / biometric verification of in-home service delivery, primarily for Medicaid HCBS / Home Care services.
- Federated SSO
- The platform's first-class integration model. Partners (EMRs/EHRs) sign JWTs with their own keypair (RFC 7519 + RFC 7517); the platform verifies and mints a tenant access token. Replay-protected via jti uniqueness.
- HCBS aka 1915(c)
- Home and Community-Based Services. Medicaid 1915(c) waiver-funded services for I/DD, elderly, and behavioural-health populations.
- I/DD
- Intellectual / Developmental Disabilities. A first-class program category on the platform.
- Master DB
- The platform-wide PostgreSQL database. Holds NPPES, code catalogs, payer registry, state rate codes, tenant directory. No PHI. Loaded once for the platform — not once per customer.
- NCCI
- National Correct Coding Initiative. CMS-maintained edits (PTP — Procedure-to-Procedure pair edits, and MUE — Medically Unlikely Edits) that prevent unbundling.
- NPPES
- National Plan and Provider Enumeration System. The federal NPI registry (~10M providers). Loaded into the master DB monthly, with weekly deltas.
- NUCC
- National Uniform Claim Committee. Maintains the provider taxonomy code set (semi-annual updates).
- Rule artifact
- A content-addressed YAML file expressing one business rule (e.g., a payer's pre-submit validation). Has effective dates, a scope, and a lifecycle (draft → in-review → approved → published → archived).
- Rule kind
- One of the eight rule families: INGEST, CHARGE_VALIDATE, CHARGE_DERIVE, CLAIM_BUILD_GROUPING, PRE_SUBMIT_VALIDATE, COMPANION_GUIDE_VALIDATE, POSTING, EVV_CONFIG. Each kind has its own schema, editor, and simulator.
- Scope
- The 7+1 dimensional matching criteria for a rule: org × site × facility × billing_entity × payer × program × service_line + state. Specificity scoring + precedence_rank determine the winning rule.
- Step-up MFA
- MFA re-assertion required for sensitive operations (impersonation, federation key management). Default freshness window is 300 seconds — outside that window the user re-asserts their factor.
- Tenant DB
- A PostgreSQL database holding one customer's data — members, charges, claims, ledger, rules, audit. Connection string sealed in Azure Key Vault. Physical isolation, no row-level security.
- Transparency in Coverage aka TiC
- CMS rule (45 CFR §158.211) requiring commercial payers to publish negotiated rates monthly. On the roadmap as a customer-facing rate-renegotiation advisory.
Provenance
The 14-document source dossier.
Every claim on this site traces back to one of the documents below, held at `docs/executive-overview/` in the platform repository.
Platform Architecture
Apps, packages, multi-tenancy, canonical model, environments
Infrastructure & DevOps
Terraform / Azure / CI-CD / cost story
RCM Application Features
Every tenant + platform-admin UI surface
EDI Gateway Features
X12 transactions, transports, routing, replay
Rules Engines & Configuration
Configuration-tab + EDI rules engine components
Master Data & Canonical Model
Canonical entities, master vs tenant DB, master catalogs, TiC strategy
Security, Compliance & HITRUST
Auth, MFA, federation, PHI, HITRUST map, BCDR
White-Labeling & Tenancy
6 brands, tenant provisioning, federated integration
AI-First Development
AI-built today, AI-embedded next, productivity evidence
Program Coverage
9 first-class program categories + state seed
Competitive Differentiation
Side-by-side vs. legacy Millin
Glossary & References
Acronyms + source-of-truth pointers
Contact
Get in touch.
If a claim on this site doesn't hold up under scrutiny, that's the conversation we want to have. The platform team responds to walk-through requests within one business day.
For platform walk-through requests, evaluation questions, or partnership conversations.
hello@medsuite.com →Walk-through
A 30-minute walk-through of any single capability — rules engine, EDI engine, master data, security model.
Request a session →Source dossier
The downloadable brief above is generated from this site. If you want the longer 14-document source dossier, drop us a line.
Request the dossier →