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Complex Claims

You’ve Got This Now

Dedicated expertise
Patient satisfaction
Faster resolution

Let our expertise and technology take the “complex” out of your complex claims.

There’s a reason they are called complex claims. Motor vehicle accidents (MVA), third-party liability (TPL) and Worker’s Compensation (WC) claims are complex and challenging. Providing a consistent, positive patient experience, while dealing with multiple parties (payers, attorneys, employers, and adjusters), plus ensuring all deadlines, guidelines, state regulations, and lien requirements are met - can create a mountain of work for an overworked revenue cycle team.

Knowtion Health can make the complex easier.

Best Practice Process

Upon placement our team triages accounts and employs our proprietary insurance discovery tool, when coverage is missing. This tool accesses insurance and litigation databases to identify known and unknown MVA, TPL and WC coverage without the need to contact the patient.

We then bill claims, monitor timely filing deadlines and follow CMS guidelines. We also appeal denials and underpayments, complete secondary billing and evaluate accounts for lien filing, if appropriate. In addition, we provide informative reporting that provides trending and ROI details.

Increased Revenue & ROI

We understand the dilemma. Managing complex claims in-house is time consuming. Patients aren’t always responsive, attorneys can be difficult, state regulations are cumbersome and your team needs to stay on top of it all. Plus, staffing can be a challenge.

All this can lead to missed deadlines, incorrect claims and missed revenue. Or worse, if you outsource to the wrong partner, you could be paying too much, or not getting the efficiencies or ROI you need to get these complex claim accounts resolved.

Plus, with up to 30% of accident accounts missing coverage information you could be leaving revenue on the table. Our insurance discovery tool provides the edge needed for even more lift over current recovery efforts. We’ve seen our tool increase revenues by over $3 million dollars monthly.

Increased Patient Satisfaction

Serving on your behalf as a patient advocate in complex claims resolution is our specialty. We triage your accounts to allocate our resources and technologies in the appropriate ways. Our patient engagement portal, three-way calls, mail, text, email, and home visits are used to improve patient engagement and resolution, while providing positive patient satisfaction.

Our 16 years of experience in processing complex claims combined with our trained 100% U.S.-based resources will help you improve your aging A/R, lower your bad debt write-offs, and limit your time and capital technology investments, all while improving the patient experience.

Faster Resolution of Accounts

We have an expert team who triages accounts to identify problems, improve processes and resolve complex claims quickly. We bill all payers as appropriate, appeal denials and underpayments and ensure your claims are compliant and resolved.

By identifying unknown coverage, including litigation, through our technology, we typically see results returned and billed in an average of 7 days.

We also work with providers to approve settlements and can, as appropriate, file and monitor liens for hospital claims. While we work every claim, those that are uncollectible are returned quickly so they can continue through your workflow.

What Makes Us Stand Out From the Rest


Knowledge and Experience

Our MVA/TPL and WC teams are made up of payer experts and attorneys who know how to engage patients and handle the mix of payers, attorneys, employers, and adjusters to maximize reimbursement.

Knowtion navigates the maze of state regulations, fee schedules, policy limits, and lien regulations to ensure recovery stays compliant.

In addition, our legal team maintains and updates a 50-state regulatory database that keeps our experts current and informed about all regulatory changes.


Single Touchpoint with Patients

We serve as advocates for both patients and providers. Our trained and expert teams of lawyers and expert claims facilitators are dedicated to thoroughly resolve claims and coordinate benefits across health and non-health payers.

Not only do we reach out to patients through pur patient engagement portal, phone calls, letters, texts, and emails, our team will also perform in-person home visits when appropriate. Acting as a single touchpoint with patients ensures a consistent and optimal patient experience.

The training and performance measurements we put in place for our internal resources and the additional hospital staff training we provide helps maximize account identification and process improvements to support our clients better.


Automation? Check. Smart workflow technologies? Check. Insurance discovery tool to find unknown coverage? Check.

Knowtion believes in working smarter. We leverage technology to maximize the efficiency of our staff, so we can maximize your reimbursements.

If your team is struggling to verify known and unknown insurance coverage for MVA/TPL and WC claims, we can help. With 30% of accident accounts having unknown coverage at the time of registration – our claim facilitators using our tool can recover on these accounts quickly and ensure no payment sources are missed. On average we locate 72% in found coverage using our specialized technology.

Knowtion Health gives you the greatest efficiency and best ROI. We invest heavily in technologies and machine learning to convert mountains of data into actionable trends and patterns and drive greater and deeper efficiencies.