Medical Claims Recovery Service

The average hospital is unable to collect more than 33-40% of billed claims from insurance companies. We can go back years and recover an additional 15%-20% per year on top of the 33-40%.

Our reimbursement and process management system equips healthcare providers with the tools, data, and business intelligence they need to reduce administrative costs and maximize revenue. The platform enables providers to identify and recover underpayments, manage denials, automate appeals and requests for additional information as well as successfully negotiate more favorable payer contracts. We identify what are considered “Zero Balance” patient claims that the facility considers Paid-In-Full.

Services

  1. HIPPA Compliant Cloud-Based Web Solution
  2. Electronic File Interfaces
  3. Ability to manage the most complex contracts and reimbursement methodologies
  4. Customizable and User-Friendly Screens
  5. Contract Modeling Tool
    • a. Powerful Analytic Reports
    • 24/7 Support

Recovery Process:

  • We will contact your Payors once we receive written consent.
  • We will only make efforts to litigate with your Payors once we receive your written consent.
  • We can work off-site or on-site to submit appeals.

Client Steps:

  1. Upload sample 837/835 electronic remittance files via web portal.
  2. Upload PDF copy of a single payer contract via web portal.

We Will:

  1. Summarize all Under Payments for a single payer.
  2. Breakdown your contract identifying 5 major points of concern.
  3. Utilize our partnerships with hedge funds, including Morgan Stanley, Merrill Lynch, and others willing to bid on the receivables found by our software. In most cases a bid will be made to purchase receivables within 72 hours.

More information