Complex Claims
(MVA/TPL/WC)

Upon placement our team triages accounts and employs Kapture, our proprietary database technology, when coverage is missing. Kapture 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 or letters of protection, if appropriate. In addition, we provide informative reporting that provides trending and ROI details.

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. Kapture provides the edge needed for even more lift over current recovery efforts. We’ve seen Kapture increase revenues by over $3 million dollars monthly.

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

Our 15 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.

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 Kapture 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 or letters of protection for hospital claims. While we work every claim, those that are uncollectible are returned quickly so they can continue through your workflow.