Complex Claims

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Remove complexity from complex claims resolution.

Motor vehicle accidents (MVA), third-party liability (TPL), and Worker’s Compensation (WC) claims are difficult to resolve. There are several parties involved, timelines to track, and regulations to adhere to, all of which put strain on resource-strapped RCM teams.

Our experts and technology help you triage complex claims, understand missing coverage, bill claims, and recover revenue faster.

See the results that matter:

  • Improve revenue recovery
  • Identify coverage
  • Accelerate time to payment
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CASE STUDY

Learn how one hospital recovered thousands in MVA revenue.

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The Challenge

One hospital with more than 800 beds and a net patient revenue of $1.2B was facing a denied claim plus an MVA bill of $425.5K. The patient’s Medicaid coverage was known, but it was unclear whether MVA insurance would cover the case because the medical issue stemmed from a bike accident. The hospital enlisted Knowtion’s help to fight the denial and maximize recoveries.

The Solution

To recover the revenue, Knowtion’s team and technology:

 

  1. Investigated coverage options, but didn’t find auto coverage. Attempts to contact the patient post-discharge went unanswered.

  2. Filed a Medicaid claim, which was denied due to possible MVA coverage.

  3. Continued to contact the patient, knowing a formal Tort appeal may be needed.

  4. Submitted a Tort appeal, including a reconsideration form, appeal letter, and notes documenting contact attempts.

  5. Followed up with the payer and routed the case for “priority appeal."

  6. Secured revenue.
Professional reviewing information on a tablet.

The Result

Knowtion’s persistence and understanding of payment processes led to a successful resubmission resulting in $300K+ in payment.

Why do leading health systems choose Knowtion Health?

We triage accounts and use our proprietary technology and data to identify missing coverage, then bill claims or appeals according to filing deadlines and regulatory guidelines.

 

Discover the Knowtion difference.

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Maximize third-party recoveries–without the complexity.

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