Why ClaimCure?

Revenue Cycle Consulting – We partner with you to improve processes and denial management to maximize your cash flow.

ClaimCure consultants are ERN Certified Compliance Consultants skilled in health administrative laws to prevent unfair payment practices and negligent utilization reviews. We bring together administrative laws across all jurisdictions (including MA, HMO, PPO, Medicaid, ERISA, and VA) with process improvements and denial management to accelerate cash flow, decrease and prevent denials.

ClaimCure consultants will observe your FTEs in the front, mid and back end of the revenue cycle to gain a complete understanding of your existing processes, and most problematic denials. Then we will analyze the processes to determine areas for improvement, as well as where and how administrative laws can be integrated to reduce avoidable losses and accelerate collections. We then provide a detailed implementation guide with findings and recommendations, along with tools for implementation. Services we provide:

• Customized policies and procedures in the admissions, authorization, transfer and appeal process.
• A denial management strategy and roadmap.
• Claim resolution on high dollar accounts.
• Training of revenue cycle staff on how to implement administrative laws to fight and prevent denials.
• Metrics and flow charts.
• Documentation and rebuttal scripts to increase cash flow.
• A library of documents and forms with integrated administrative laws such as UM fax cover sheets, appeal and demand letters, law appendices.
• Payer-provider contract review and analysis with recommendations to decrease administrative burdens, increase net revenue yield, and reduce avoidable losses.
• Strategic consultations on specific denial issues.
• Specialized template appeals and fax cover sheets for specific issues identified.
• Onsite or remote consultants to work as an extension of your revenue cycle team.

Pre-litigation Revenue Cycle Consulting – We partner with you to determine the next steps for unresolved accounts.

ClaimCure consultants can assist in determining what the next steps should be for accounts where appeal and collection efforts have been exhausted. We can review and analyze the accounts to determine if there are unfair payment trends that should be escalated to regulatory agencies based on administrative laws; Review and analyze accounts along with provider-payer contracts to determine if litigation should be considered; and assist in preparing cases for litigation. Services we provide:

• Claim denial root cause determination and analysis in conjunction with health administrative laws and provider-payer contracts.
• Unfair payment trend analysis and reporting for regulatory complaints.
• Pre-litigation analysis and recommendations on unresolved accounts.
• Document collection and review for litigation.
• Case materials/evidence preparation for litigation.
• Expert witness services.