Our Healthcare Payment Recovery Services include:
Subrogation
Our sophisticated investigation process identifies all potential sources of recovery, including motor vehicle accident, product liability, premises liability and medical malpractice.
After systematically uncovering claims that should have been paid by another party, our team works closely with our legal staff to achieve the best possible settlement for you.
Coordination of Benefits – Section 111, MSP Validation, Duplicate Payment Identification, Retro-terminations, Workers’ Comp Offset
We provide supplemental Coordination of Benefits (COB) and recovery services, helping your internal COB efforts identify and recover benefits paid where Medicare or another Payer should have paid primary. We share this updated information with all stakeholders, so processes can be corrected and accurate payments can be made in the future.
Hospital Credit Balance Audits
As the second-largest credit balance vendor in the U.S., we work on your behalf to recover duplicate and similar claim overpayments, COB errors and payments that exceed your contractual requirements. We ensure timely recovery of credit balances on the books of hospitals throughout your service area.
End-Stage Renal Dialysis Analysis and Audits
We review 100% of primary payments made to each dialysis facility. We review both Provider- and Payer-supplied documentation to maximize recovery for you.
HIT, DME, Pharmacy Benefit Management Analysis and Audits
Our auditing procedures and proprietary software focus solely on overpayment drivers in Durable Medical Equipment (DME) and Home Infusion Therapy (HIT). Our unique technology, in combination with our team of pharmacy professionals with real-world HIT/DME experience, result in greater recoveries for our clients.
Utilization and Disease Case Management
We employ a URAC-accredited care management approach that combines clinical expertise and technology tools. This approach provides comprehensive, customized large-scale modeling, profiling, health risk prediction and data-driven management solutions. And it delivers solutions that:
- Improve healthcare delivery and quality
- Promote medical best practices
- Reduce costs.
And, since we’re a designated Quality Improvement Organization (QIO)-like entity, we provide utilization and disease case management reviews.