Payer Disputes & Contracting
With the changing reimbursement landscape, overpayments and underpayments are very commonplace in the managed care world. Have your claims been denied and appealed multiple times without success? We support physician groups in the outreach to health plans to fight wrongfully denied or underpaid claims. We work with groups to determine the financial impact of the unpaid or underpaid claims and work with payers to have them either reprocessed, carried against future or paid as a settlement to the group. When payers notify groups of under payments, we will work with your revenue cycle teams to validate the accuracy of those payments.
If payers do not respond in a timely fashion and we determine they are in violation of your payer agreement we work with various law firms to enforce your contractual rights. Most contracts require providers to go through arbitration which we support the client through the entire process.