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We can identify coverages which may not be known to the client as the benefit payer. After a coverage is identified, we conduct studies that can identify improperly billed, processed, or paid claims for professional or institutional services in the client's commercial membership population.
-Worker's Comp Coverage Identification
-Casualty Coverage Identifcation
-Medicare Coverage Identification
-Disability Coverage Identification
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We are experts in Medicare, Medicaid and Coordination of Benefit rules and regulations at the Federal and State level allowing us to identify claims paid improperly and identifying the appropriate liable party allowing the client to cost shift all or part of it's liability.
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Property / Casualty claims (Other carrier liable)
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Motor Vehicle Accidents (Other carrier liable)
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Medicare covered claims (Medicare liable)
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Disability claims (Medicare / other carrier liable)
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Medicare Secondary Payer
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Medicaid
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We create and run proprietary algorithms that identify when a client has inappropriately paid providers due to provider mis-billings or claim edit insufficiencies or misinterpretation of benefit plan provisions. We assist the client in recovering overpaid amounts where appropriate; cost avoid where possible; and updating their records for ongoing compliance.
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