Our results speak for themselves. To date, we have analyzed billions of dollars in reimbursements and remittances against thousands of unique and often complex payor contracts and have found noncompliance and underpayments for 100% of our clients. What does that mean for our clients? The typical result is 10%-20% of gross payor receipts in recovery.
We work solely on a contingency basis. There are no upfront fees, costs, or ongoing tasks required from our clients. We take on 100% of the risk and effort to recover revenues for our clients. We are only compensated when we successfully recover underpayments. THATS RIGHT! We only get paid if we find you $$$.
Forensic analysis
Our contract specialists load the payment rates and terms of the healthcare provider's existing Payor Agreements in the Contract Module.
We work with your Billing Department and its claim Clearinghouse to upload its ANSI ASC X12 837/835 electronic files using our HIPPA-compliant, proprietary encryption platform
Using these two sources of critical data, our team of experts and software logic identifies variances in the payment reimbursement and your contractual agreement with the Payor. The resulting data is organized in an easy-to-use, understandable format.
As your partner, we will work closely with your staff to strategize and devise a plan to recover revenue lost due to underpaid, suspended, and incorrectly denied claims.
Contract Modeler
Our Contract Modeler is designed to "plug and play" reimbursement scenarios, rates, and contract terms using historical claim utilization data to determine revenue outcomes based on a provider's specific case/service mix.
This valuable tool allows the healthcare provider to assess the payor's contract proposal's impact and identify opportunities to maximize revenue.
Our team of specialists is composed of experienced professionals having worked in administration, operations, and contracting with major payors.
Additional consulting services, as well as contract negotiation services, are available if needed.
Analytics / Reporting
All data elements captured in the electronic 837/835 files are defined by CMS and housed in a secure client-specific environment on our HIPPA-compliant/encrypted server.
We offer a suite of standard claim utilization reports and the ability to provide customizable, user-friendly reports.
This comprehensive capture of all data related to a healthcare service experience provides a picture of the healthcare provider's need to evaluate current and future operations.
