Nationwide Healthcare Consulting & Management Support
AMS Healthcare Consulting
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Signature methodology

The Apex 5C™ Framework

Five connected pillars that define a healthy healthcare operation — Compliance, Contracting, Credentialing, Correct Coding, and Claims Assurance — managed as one system, not isolated projects.

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C1

Compliance¹

Regulatory compliance program design, HIPAA safeguards, audit readiness, policy development, risk management, and corrective action.

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Scope

  • Regulatory compliance program design and review
  • HIPAA Privacy & Security safeguards
  • Audit readiness and survey preparation
  • Policy and procedure development
  • Risk management and mitigation planning
  • Corrective action planning and monitoring
C2

Contracting²

Payer contracting, fee schedule negotiation, vendor contracts, lifecycle administration, and contractual obligations.

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Scope

  • Payer contract negotiation and review
  • Fee schedule analysis and benchmarking
  • Vendor and supplier contract administration
  • Contract lifecycle tracking and renewals
  • Terms, obligations, and compliance monitoring
  • Network participation strategy
C3

Credentialing³

Provider credentialing, Medicare/Medicaid enrollment, recredentialing cycles, and payer participation management.

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Scope

  • Provider credentialing and primary source verification
  • Medicare, Medicaid, and commercial payer enrollment
  • Recredentialing cycles and expirable tracking
  • Payer participation and panel management
  • CAQH ProView profile maintenance
  • Credentialing committee support and documentation
C4

Correct Coding⁴

Coding compliance audits, documentation integrity, code accuracy review, and reimbursement risk management.

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Scope

  • Coding compliance audits and reviews
  • Documentation integrity and specificity review
  • Code accuracy and modifier validation
  • Charge capture and coding workflow review
  • OIG and payer audit response support
  • Internal coding education and feedback
C5

Claims Assurance⁵

Claims analysis, denial prevention, payment integrity, reimbursement monitoring, and revenue protection.

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Scope

  • Claims and denial trend analysis
  • Denial prevention and root-cause review
  • Payment integrity and reimbursement monitoring
  • Accounts receivable and aging review
  • Appeals and reconsideration support guidance
  • Revenue cycle key-metric reporting
A diverse healthcare advisory team — Black, Hispanic, and Asian American professionals — collaborating on compliance and operational strategy in a modern office.

One framework. Five pillars. Managed end to end.

Compliance issues surface in contracting. Contracting problems show up in credentialing. Credentialing delays cost claims. The Apex 5C™ Framework treats all five as a single operating system — and the AMS 360™ retainer keeps it running.

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