Managed care denial recovery is our strength. We can supplement your internal resources or accept a complete outsourcing of all denials.
- Appeals of Managed Care, Medicare and Medicaid denied claims and RAC
- Payer specific issues
- Hospital coding or billing errors
- Managed care contract analysis
- Clinical staff explore the medical record and work with the treating physician
- Sophisticated appeals written to pinpoint the facts in support of the claim
- Team meetings with provider staff and payor to review details and expedite payments
- Custom reports to identify and track denial trends, used to prevent future denials
Our team analyzes proposed rate increases. Using our proprietary software we target pricing changes. We give the hospital a complete understanding of the impact the new rates and prices will have on revenue from that payer.
Our software electronically identifies underpayments by comparing the managed care contract with the 835 file. We assemble the data into work queues to automate and track the recovery efforts. We ensure managed care contract compliance.
Billed Claim Follow Up
We electronically identify from the hospital legacy system billed claims that are neither denied nor paid. Our staff investigates using the payer web site to validate the claim status. Appropriate follow up takes place, grouping claims by payer to resolve multiple accounts.
Paid Claim Review
Comparing the managed care contract terms with the payment files will validate the contractual write off and the amount paid. This retroactive look-back, using our proprietary software, has recovered millions of dollars for our clients over the years.