Billing and Invoices

Profound Health bills a fixed-fee fair market value for CoCM services while keeping partners fully informed. Stripe handles collections for our service fees; detailed ledgers live in Supabase and surface through the Partner Ops Portal.

Pricing

Pricing: fixed-fee $10 per Active Patient Month (APM); Net 15.
APM definition: a member with ≥1 qualifying CoCM interaction in the calendar month.
Audit-Ready Credit (ARC): if a denial is solely due to our documentation/coding defect, we credit that member-month on the next invoice.
No rev-share: fees are not tied to collections, payer mix, or minutes attained.

Workflow Overview

1. BHCM minutes accrue in the provider portal with CPT mappings (99492-99494).
2. At month end, we aggregate approved minutes and generate your monthly service invoice (unrelated to payer reimbursement amounts).
3. Partner Ops reviews and signs off; Stripe invoices are created via API.
4. Payments post back through Stripe webhooks (internal) and update partner ledgers.

Invoice Anatomy

Component	Source	Description
Header	Partner contract	Practice name, billing period, payment terms.
Line items	Supabase billing.ledger_entries	Per-patient monthly service fees with references to artifact bundles.
Attachments	Compliance vault	Signed case review summaries if required.

Payment Options

• ACH Auto-Debit: Recommended. Stripe manages verification and recurring pulls.
• Manual ACH/Wire: Partners receive ACH instructions; Ops marks payment received in the portal.
• Credit Card: Available with pass-through processing fees.

Dispute Handling

• Partners can dispute line items directly in the portal. Disputes pause Stripe payment attempts until resolved.
• Each dispute requires supporting documentation; Ops can download encounter summaries in one click.

Consent and Cost-Sharing

• CoCM participation requires documented patient consent; we maintain consent timestamps and registry status in monthly artifacts.
• Standard payer cost-sharing may apply to CoCM (for example, Medicare coinsurance for BHI/CoCM). Policies vary by plan; partners should advise patients based on their payer mix.

Nationwide Readiness

Nationwide model with state-by-state activation: The operating model supports all 50 states. Go-live by state and payer depends on clinician licensure and payer readiness and is documented during onboarding.

Reporting

• Monthly revenue reports export as CSV with all CPT and HCPCS codes for partner accounting systems.
• Dashboards highlight AR aging, denial rates, and eligibility failures.

Consistent Cutoffs

We close billing on the 3rd business day of the month to give clinics time to finalize documentation without delaying invoicing.

For detailed ledger schemas and automation hooks, see the internal Billing Playbooks (private).