Expert review and analysis of your out-of-network claims to identify recovery opportunities.
Our claims analysis service provides a thorough examination of your out-of-network claims to identify underpayments and opportunities for revenue recovery. We use sophisticated data analytics and industry benchmarks to determine the fair market value of your services.
The MedResolutions team evaluates each claim against regional averages, Medicare multipliers, and contracted rates to build strong cases for arbitration. Our clinical expertise adds additional weight to your claims during the dispute process.
We analyze historical payment patterns from insurers to identify systemic underpayment issues and develop strategies to address them. This comprehensive approach ensures no potential recovery is overlooked.
After analysis, we provide detailed reports showing recovery potential and recommend the most effective approach for each claim. This data-driven method consistently yields higher reimbursements for our clients.
FAQ
No. Federal IDR generally applies to specific No Surprises Act categories, including out-of-network emergency services, certain out-of-network providers at in-network facilities, and out-of-network air ambulance services. MedRes screens claims before recommending a recovery route.
Some claims are better handled through appeals, payer escalation, contract analysis, or a decision not to pursue. The first step is identifying the route that matches the claim facts, plan type, service category, and economics.
MedRes generally works on a recovery-aligned model. The commercial structure depends on the engagement and matter type, but the goal is to align incentives around collected reimbursement rather than activity alone.