Services

Recovery Services

This is our base service of exhausting your administrative appeal rights under ERISA for any private insurance claims you select as far back as January 1, 2003.

We encourage our clients to select those claims that have “gone cold”, where all the previous efforts of your internal staff and/or external service have failed to render 100% of your billed charges (or even a percentage approximating that).

These should be assigned to CRC only when no other individual or entity is actively persuing any action with a payor.

Overpayment Appeal

This service has us appeal erroneous claims for “reimbursement of overpayments” made by third-party payers. CRC assists with the management and handling of erroneous claims for reimbursement by third-party payors, and is paid a percentage based on the face value of the demand.

Strategic Payor Relations Guidance

This service is appropriate in determining a strategic course of action for a single payor in your market or an overall strategy with payors. This can also be used for a single contract strategic overview during a contract renewal or negotiation. This service may also apply to discussions regarding other entities related to you such as physician groups or third party providers where you are in cooperative or adversarial strategy development regarding payments.

We do have knowledge and key information or associations for other issues that may represent a significant need in your facility. Please feel free to engage us in an inquiry on any reimbursement subject and we will be pleased to refer you to an appropriate response.

Litigation Support

Often CRC will be asked to perfect the “exhaustion of all administrative remedy” in cases planned for submission to federal court or to ensure that all files contained in a complaint have been fully exhausted on the administrative side of ERISA for the judicial engagement.

These cases are generally, not brought to litigation by CRC on behalf of its clients, but brought to us by litigation teams determined to prevail in their planned actions.  In such cases, CRC’s industry insight, knowledge and data base of hundreds of thousands of claims can be brought to build a case file that has a very strong chance of surviving multiple strategic attacks.