More Information Medical Claims

We have a proprietary forensic auditing software program that identifies underpaid and improperly denied insurance claims for medical institutions as they relate to the contractual reimbursement covenants with their insurers.

Typical billing and collection protocol is to bill, check for billing and coding errors, then re-bill again. The average hospital collects only 33-40% of billed.

Our programmers and analysts understand the nuances of your contract with your insurer which typically are intended either to deny, delay or minimize your reimbursement. Our team has experience as contract negotiators on the Payor side and know the language, terms and reimbursement methodologies. We understand the algorithms and intentional “contract confusions” that directly affect your reimbursement. This is what makes us unique.

Insurance contracts are confusing and designed to maximize the insurance companies’ profits, not yours.

We do not replace or compete with your in-house or third-party billing efforts. Our analysts work with your existing billing team and protocols to increase your collections based on our ability to understand the legal issues in an insurance contract and use analytics to identify your contract underpayments.

It is unfair to ask those who bill to be experts in reading and understanding contracts.

It takes 30 minutes or less for a billing person to upload their 835-electronic billing to us in a HIPAA approved drop box.

All we need at this point is an email with one insurance contract to read and upload to our system. Both parties sign a BAA giving us the legal right to evaluate the insurance company’s payments to the facility. Once given the proper electronic files we normally have results in 2-3 days.

This is not an evaluation of the current billing people but rather a forensic analysis of your insurance contracts.

Upon completion of the analysis of the one insurance contract, we will provide the hospital with a report showing the discrepancies in underpayments after taking out patient liability and previous insurance payments. We will also provide a study that will evaluate the probability of collection of the underpayments.

We provide services that will further enhance your reimbursements. These options can be explored once we prove our value.