Hire Ventus,Your AI Ophthalmology Revenue Cycle Team.

Ophthalmology Revenue Cycle Management (RCM) is the end-to-end financial process eye-care groups use to get paid for care: prior authorization for anti-VEGF injections and surgery, coding for exams, injections, and ASC procedures, routing between medical and vision plans, answering payer requests for records, payment posting, and follow-up. Ophthalmology is unusually exposed at three points: recurring injection reauthorizations that lapse, payer requests for the OCT or operative report behind high-dollar claims, and buy-and-bill claims that bounce on J-code units or laterality. Ophthalmology RCM automation puts AI agents on exactly those three.

Ventus is the payer intelligence layer built for ophthalmology and optometry groups. It works inside your existing EHR (Nextech, ModMed, Epic, or NextGen), logs into payer portals, clears prior authorizations and reauthorizations on injections and surgery, answers payer requests for additional information the day they arrive, and scrubs and submits clean claims — communicating with your team in Slack or Teams the whole way.

Ventus reads the injection schedule, assembles what each payer’s policy asks for — diagnosis, OCT central subfield thickness, visual acuity, step-therapy history with bevacizumab or a preferred biosimilar, dose and units — submits through the payer portal, and follows every request to a decision. Approvals are written back to the EHR with the auth number, approved injections, and expiry; step-therapy exceptions and peer-to-peers are scheduled with your provider; and reauthorizations are filed before the 4-to-12-week cycle lapses, so a patient is never injected on an expired auth.

Yes. For cataract surgery, blepharoplasty, and other procedures that require authorization, Ventus assembles the medical-necessity documentation payers require — acuity with glare testing, functional impairment, visual fields taped and untaped, photos, pre-op notes — submits it, and tracks the request to approval, including the ASC site of service.

Ventus reads the request as it posts — a “claim lacks information” remark, an attachment-required code, or a records letter — identifies exactly what was asked for (the OCT and acuity behind an injection, the operative report on a cataract case, the drug invoice and NDC for a J-code, the step-therapy history for a non-preferred drug), pulls it from the EHR, packages it to the payer’s specification, and sends it back the same day via portal attachment, corrected claim, or fax. It logs the confirmation and tracks the claim to adjudication, so a 30-day window is answered on day one.

As encounters close, Ventus builds each claim from the note and the authorization on file, then scrubs it against that payer’s rules: J-code units and NDC checked against the documented dose, RT/LT laterality and laterality-specific diagnoses, modifier 25 kept only when a separate exam is documented, bilateral procedures split per payer policy, ASC facility and professional claims separated, and routine exams routed to the vision plan rather than the medical plan. It submits through your clearinghouse, reads the acknowledgments, writes the claim status back to the EHR, and routes any rejection for a same-day fix.

Yes. Ventus handles the split a single cataract case creates — the ASC facility claim, the professional claim, and any optical claim — routing each to the right payer with the right place of service, and answers the operative-report requests these claims attract. Routine vision exams and materials are routed to the vision plan so coordination-of-benefits denials don’t pile up.

Ventus works directly inside your existing EHR and practice management system including Nextech, ModMed, Epic, and NextGen. It logs in just like a team member would: reads the schedule and notes, pulls OCTs and operative reports, builds and submits claims, writes auth numbers and claim statuses back, and posts payments. No API integration required.

Ventus logs into 40+ payer portals including Aetna, Cigna, UnitedHealthcare, Anthem, BlueCross BlueShield, Humana, Medicare, and vision plans, plus clearinghouses such as Availity. It submits prior auths, uploads requested records, and gathers claim statuses directly from the source.

Ventus confirms clearinghouse and payer acceptance the same day and follows the claim until it pays. Because claims go out authorized, documented, and clean, most simply adjudicate. For the few that stall or come back with a request, Ventus answers the request or supplies the missing information, and surfaces true exceptions to your team with full context.

Yes, Ventus is fully HIPAA compliant and SOC 2 Type II certified. We maintain enterprise-grade security with bank-level encryption, role-based access controls, and continuous compliance audits.

Ventus can be live in about 7 days. Our team maps your payer mix and EHR, configures the AI agents in your environment — usually starting with injection reauthorizations and payer records requests — and gets you running with minimal disruption to your operations.

Eye-care groups using Ventus see injection authorizations and reauthorizations cleared before the visit instead of lapsing mid-cycle, payer records requests answered in a day instead of weeks, and buy-and-bill claims that go out with the right J-code units, laterality, and plan the first time — which lifts first-pass acceptance and protects the margin on every $2,000 dose. Ventus runs 24/7 inside the EHR your team already uses.