From paid claim to money back
Every engagement runs the same five steps: authorize, open the data, audit every line, dispute the errors, and return the money. Then the loop starts again on the next claim.
Follow a claimWe start by signing the documents that keep you and us safe
We start every engagement with three documents. We don't move until they're in place.
- HIPAA BAA. We're required by law to have this in place before a single claim line moves. Read the BAA template.
- Letter of authorization. This names us your authorized representative with the TPA.
Legal standing with the TPA from day one.
Figures are illustrative.
You send us your books
The TPA releases the full claims history.
- Full history. We pull EOBs, remittance data, and itemized bills for large claims, plus the summary plan description.
- Real benchmarks. We score every claim against independent cost benchmarks.
- Nothing left behind. Every claim is scored and queued, so no bill slips through unreviewed.
Now we review every line
We request the itemized bill and compare it against the EOB, the plan document, and clinical standards.
Every line checked against the EOB and the plan document.
Line-level detail
Every line carries a code, so we catch the errors in the comparison.
Clinical review
A dispute without clinical justification loses. Ours are written to the record.
The odds are good
Industry audits find errors on roughly 4 of 5 hospital bills.
We document every potential dispute
Precise to the exact line, exact code, exact reason.
- Deadlines tracked. Providers typically respond in 30 to 60 days. TPAs reprocess in about 30. We hold both to it.
- TPA errors too. We don't let adjudication mistakes get a pass; they get a claim adjustment request as well.
Figures are illustrative.
Figures are industry-benchmark illustrations, never client data.
We send back a full report
We show claims audited, errors documented, dollars recovered, our fee, and your net savings.
- Every quarter. We send one document: every dispute, tracked to the dollar.
- The audit never ends. We watch every new claim until the end of the fiscal quarter you signed with us, and nothing ages out of the recovery window.
- Provider intelligence. We score clean-claim rates and flag watchlist providers so you know who bills honestly.
The money comes home
Three documents and a claims feed is all it takes to start. The audit does the rest, and the recovery lands back in the plan's fund.