Medical Underpayments
The Company & Who We Serve
The company has been in business since 1998, created by a group of healthcare and insurance experts to apply technology to the process of resolving disputed healthcare claims, with a particular focus on small balance claims to significantly improve provider financial recoveries.
The process of appealing healthcare claims is unique, involving specific adjudication processes. There are hundreds of billing companies in the marketplace that bill medical services – we uniquely supplement billing with a unique, patented, and automated appeals technology platform, providing a major advantage for clients in recovering disputed healthcare claims.
Clients include hospitals, physician groups, emergency medical services, durable medical equipment suppliers and laboratories. We also enhance the service capabilities and revenue of medical auditing firms for their clients.
Benefits to Your Business
We help medical providers maximize denied, small balance, and underpaid claims from all commercial third party payors. As small balance claims increasingly lead to costly write-offs, we offer a proven solution that recovers up to 42% of these claims within the first 30 days, all on a low, contingency-fee basis.
We also forecast your recovery based on data you provide. Our projections are highly accurate, with a margin of error within 2% after the initial year.
Client Success Stories
- Client 1 – 30% increase in recoveries, 85% increase in payments.
Also reduced staff by 32 RCM reps that were doing follow-up work
- Client 2 – Recovered an additional $12.3M from work performed by prior vendor
Claims were aged 6-24 months
Consistent. monthly recovery percentage of 19-20% of claims worked
- Client 3 – Claims prior to January 2022 continued to pay to January 2023
$4.2 million claims appealed in 2018 paid $1M over subsequent year
January 2023 payment – one year later = $265,000
- Client 4 – High recovery rate ranged from 38.6% to 52.9% of all appeals
Average of 47% recovery on first appeal (payment within 30 days)
- Client 5 – Payer detail:
Payer Response: 23% – 96%
Payer Payment: 31% – 96%
We Provide
- 42% of claims paid within 30 days and 73% within 90 days
- No upfront costs or maintenance fees
- A patented appeals process ensuring claims are paid in accordance with state insurance laws
- Targeted work on all claims (down to $25), including legacy claims over 180 days old
- Low, negotiable contingency fees
- The flexibility to lease our patented software platform for automated claims follow up and recovery to supplement your existing RCM program