claims recovery service

Claims Recovery Service

Prerequisites

• Treat patients with commercial health insurance and/or out-of-network

• Possess/have access to claim records: + 835s – Electronic Remittance Advise (ERAs)+ 837s – Explanation of Benefits (EOBs)+ Supporting Claim Documentation

Important Facts to Consider• Protean is a RECOVERY Service (not apart of billing or collections)

• Our service does not replace a practice’s current processes in regards to writing off claims

• The Claims Recovery Service has successfully recovered hundreds of millions of dollars for medical providers since 2004

• The Claims Recovery Service is HIPAA compliant

• The Claims Recovery Service is patented, and is the only such system in the U.S. for utilizing the ERISA (Employer Retirement Income Security Act) Office of Appeals

Denials – The Heart of the IssueThe U.S. Government Accountability Office (GAO) has stated that 0.05% of all denied claims go to the ERISA Office of Appeals – 1 out of every 200 denied claims. The GAO has also stated that for every 200 claims that would go to the ERISA Office of Appeals, between 78 and 118 of those denied claims would be reversed!

The Importance of ERISA

As a practice/physician, U.S. Federal ERISA Law means a great deal to you:

“Intermediaries (payors) only have the authority to pay claims and NOT deny payments.”

“Anytime a healthcare provider is paid less than 100% of total bill charge, that claim is hereby defined as a denial.”

We’re Here to Help

At no upfront cost, our Claims Recovery Service will investigate, analyze and reverse medical provider denied claims dating back as far as 2003through the ERISA Office of Appeals.

The Process+ Mid-to-large Medical Providers (Claims over $10,000)

1. Records: Provide claim records (837 – EOBs) and any supporting claim data.

2. Timeframe: 2-8 months

3. 100% of the recovered dollars are returned directly to the medical provider by the payor(s) via demand letters sent directly from the ERISA Office of Appeals.

4. The medical provider will then pay Protean a fee of 50% of the total amount recovered.

The Process+ Small-to-Mid Medical Providers (Claims under $10,000)

1. Digital Records: Provide digital records (835 – ERAs / 837 – EOBs). A secure HIPAA compliant dropbox is sent to the medical provider so that the files can be uploaded for analysis & submission. We have a data extraction team should access to data prove difficult.

2. Timeframe: 1-3 months

3. 100% of the recovered dollars are returned directly to the medical provider by the payor(s) via demand letters sent directly from the ERISA Office of Appeals.

4. The medical provider will then pay Protean a fee of 50% of the total amount recovered.

First (and Last), Do No Harm:

The fee is contingent based off of the total amount recovered.No fee is owed to Protean/MedLink if the medical providerdoes not receive any recoverables.

There is only one question to ask yourself:

HOW MANY OF YOUR DENIED CLAIMS HAVE GONE THROUGH THE ERISA OFFICE OF APPEALS?

Next Steps

Review & execute our Service Agreements:

+ ERISA Claims Recovery Agreement+ Non-Disclosure Agreement+ Business Associate Agreement

Contact Information

M&P PartnersRegional Account Managers

James Mathis james@mathispaquette.com

Tim Paquettetim@mathispaquette.com

P 817.239.2399