Provider ERISA Claims Review

 

  • Has your organization or practice suffered from denied medical claims?
  • Are you certain your Claims Denials Appeal staff regularly use ALL the ERISA Affirmative protection afforded to you by federal law?

ARC and their Affiliates are leaders in healthcare reimbursement recovery. Serving providers, plan administrators, medical device companies and billing organizations in actions involving denied or disputed medical insurance claims. Our affiliates are experienced ERISA/PPACA Claims Appeals specialist who have filed thousands of ERISA multi-level appeals and realized significant recoveries of “dead” or “written off” accounts receivables.

From assisting providers in disputes with payors to creating customized compliant programs and policies, ARC and their Affiliates help their clients manage their assets and enhance their profitability. For healthcare provider customers who have had problems obtaining proper payment from insurance companies, ARC and their Affiliates can become their Virtual Appeals department.

ARC and their Affiliates will handle all aspects of the appeals process, including analyzing client data, composing ERISA appeal letters, handling incoming calls and negotiating full settlements.

We accept any dead claims you consider unrecoverable

For healthcare provider customers who have had problems obtaining proper payment from insurance companies, ARC can become their Virtual Appeals department.   ARC will handle all aspects of the appeals process, including analyzing client data, composing ERISA appeal letters, handling incoming calls and negotiating full settlements.

We accept any dead claims you consider unrecoverable

We bring decades of specialist experience in:

  • ERISA regulations and DOL guidelines relating to health care claims
  • Application of various court case rulings in regard to ERISA and how they can be used in ERISA appeals
  • Traditional medical billing and revenue cycle management (RCM)

Specifically, we can:

  • conduct audits of facilities or practices to identify areas of deficiency or vulnerability with respect to reimbursement issues
  • recommend policies and best practices to streamline the reimbursement processes, control costs and keep up with changing regulations
  • evaluate and develop explanation-of-benefits strategies using ERISA/PPACA compliant appeals perform onsite training or remote assistance and support. ARC services:
  • contingency basis recovery
  • audit denied claims (proprietary methodology)
  • with high accuracy, estimate your recoverable revenue from wrongly denied medical claims
  • traditional scrubbing of Accounts Receivable, scalable to $100 million every 4 days
  • proprietary scrubbing using ERISA rules based algorithms
  • collections above traditional methods of up to 60% of billable
  • full reports generated for your practice and your internal or outsourced billing staff
  • For customers with special needs (e.g. bankruptcy, auditing, plan design, legal advice), ARC has an expanded offering, customized to each situation. We will leverage our extensive knowledge of ERISA law, DOL guidelines and supporting case law, and can often provide attractively priced specialty services previously available only to large companies at large-company prices
  • The ERISA Act was written to protect you and your employees. ARC normally recovers 100% of your contracted payment, minus the patient’s responsibility, regardless whether you are an in-network provider or an out-of-network provider

 

What is recoupment?

Recoupment is the identification of insurance claims that were either denied or underpaid to the provider and overpaid and not reimbursed to the self-funded employer. ARC and their Affiliates will help identify these claims and assist in the process of getting adjusted compensation back to the proper stakeholder. Recoupment recaptures money owed to employees for their health benefits. Recoupment also sends a clear ‘signal’ that an employer is responsible and is taking care of the well-being of its employees

Patient – The patient benefits because they have access to services that might otherwise be denied because their provider of choice may be out of network for example

Provider – The provider is properly compensated for the services rendered regardless of network status, which allows them to treat patients they might not otherwise treat

Self-funded employer – The Employer is sure to get reimbursed for claims volume they may be over paying the TPA/Insurance Plan for the claims they have adjudicated

  • ERISA – improper recoupment hurts our doctors.
  • ERISA – improper recoupment hurts employers – when funds are not forwarded to plan.
  • ERISA – these improper activities hurts patients by increasing the cost of care

ARC and their Affiliates technology platform will report and show your practice, your billers whether internal or outsourced:

  • identify claims that are denied and that can be appealed
  • each denied claim is managed by ARC and their Affiliates and then a report assigned to your staff person or biller
  • we process that denial and then appeal and recover you’re previous denied reimbursements.
  • the payer then issues the reimbursements of previously denied claims to YOUR PRACTICE
  • then submits an invoice for a contingency recovery fee.
  • offers tools and optionally trains your staff how to minimize future claims denials.
  • ARC & Affiliates provides the ERISA appeals language and liturgy to ensure YOUR PRACTICE maximum leverage to recover denied dollars litigation if possible;
  • your staff and biller will acquire an in-depth review of denied claims with integrated reporting

Denial Claims Appeals Management
ERISA Appeals Management

  • Think about how much of your staff time is invested trying to even identify denied claims when compared to working and appealing denied claims!
  • Reducing the time researching for problem claims and responding to payers requests for “More information” allowing your staff more time to resolve problem claims
  • Your practice experiences all sorts of claims denials:
    • Insurer requests “More Information”
    • You often see EOBs with ‘ZERO dollars’;
    • The Payer just plain denies your submitted claims;
    • Your Work Comp claims are underpaid;
  • Your staff must sort through hundreds of Payer EOBs where the technology platform that ARC and their Affiliates provide simplifies this process!

 

ERISA Templates Claims Denial Template letters
Patient Deductibles Not Met Denials

  • Claims Denial and ERISA letter templates:
  • Save your staff time by automating the process and repetitive process of manually entering data for Appeals Letters!
  • Work Comp appeals for Underpaid Claims or Denied Claims automates the loading of the files needed for processing these underpayments and Denials;
  • Our platform includes the patient payment information that meets plan specs so no longer does your practice have to suffer from claims denied on erroneous patient payment data provided to you from the payer
  • Our platform access its direct connectivity to determine not just the eligibility of the patient but the patients payment specs

 

ARC & their Affiliate partner has connectivity to over 400 payers and thousands of plan specs

ARC’s motto is “Transparency Ensures Compliance”   Our point of differentiation is that our plan’s payments are transparently auditable in real time, ensuring full worry-free compliance to ERISA and PPACA federal law. Transparency takes the pain out of compliance. Transparency means you can talk frankly with us about your needs and worries and be confident will always respond in kind. Transparency means we cannot offer any service we cannot fully back with confidence and delivery

For healthcare provider customers seeking ongoing help, we offer to become their provider (Hyperlink to Plan Design).   We deliver our assessment and new Plan Design proposals to agreed timelines. ARC and its affiliate’s plans are transparent, portable and typically generate 20% cost savings.   We also offer corporate wellness solutions, concierge medicine, etc. Most importantly we provide transparency in real time, thus supporting your compliance to PPACA and ERISA

Request an Online Webinar or Register for a complimentary consultation (Hyperlink) to see how our Platform can improve your workflow when it comes to managing all of your claims and minimizing problem claims going forward!

To have one of ARC’s representatives contact you email admin@arcrecovery.com or click “Register”  to sign up for a complimentary consultation