Examples of
Our Service Offerings
Retrospective
Solutions
include:
Implementing proprietary analytics to define scope of opportunity and best path to collection
Utilizing sophisticated termination clauses
Retaining of nationally-recognized lawyers to seek “Cease and Desist Orders” to stop current health plan illegal activities (e.g. utilization review and prior authorizations)
Retention of nationally-recognized class action lawyers to seek corrective actions and damages for health plan misconduct and contract breaches
Prospective Solutions
include:
Reviewing existing contracts for rates, terms and “catch” phrases health plans use as weapons to down-code and deny payments of services to providers
Providing strategies for amendment and renegotiation of unfavorable contract provisions with health plans
Implementing denial management capabilities and systems to identify and counteract health plan denial practices
Providing management and technology-enabled controls to monitor health plan obligations to providers
Our Approach Is a Comprehensive Suite of Solutions
Tailored to address each client’s circumstances, interests and capabilities
Explore & Discover
Contracting Status
KPI Benchmarking
Technology Profile
Organization Profile
Identify & Prioritize (Examples)
Inappropriate Denials
Inappropriate Case Classifications
Inappropriate Down-coding
Inappropriate Contract Interpretations
Inappropriate Discounting
Notify & Pursue (Examples)
Claims Resubmissions
Arbitration
Class-action Law Suits
Single-Defendant Law Suits
Demand Letters
Settle & Collect
Legal Decisions
Legal Documents
Commercial Agreements
Receivables Collection
​Enhance Operations Effectiveness
RCM Strategy and Development
Clinical and RCM Process Redesign
Customer Relationship Management Strategies
RCM Technology Modernization
Payor Contracts Redrafting