Claim Solutions, LLC

claim solutions innovative services

About Us

Our mission

Bringing innovation to the claim payer, a pillar of support and Claim Solutions.

Experience

Claim Solutions, LLC’s core management team has well over 75 years of collective experience with claim/insurance operations, cost containment, and claim consulting, which includes knowledge of, and expertise with, billing/coding rules and guidelines, bill reviews, claim auditing, and claim negotiation, as well as handling of fully insured, self-funded, stop loss, and reinsurance claims.

Our hands on "White glove" approach

our client services

Our team consistently provides outstanding service and is dedicated to delivering great results. Claim Solutions focuses on our clients’ needs and we know that no two claims are exactly alike, which is why we offer many different types of services and solutions. With our Pre-Screen approach every claim is reviewed and the best opportunity for savings are identified.

Here are some of the service solutions we provide:

Medical Bill review

Healthcare billing is wrought with inefficiency, complexity, fraud and abuse.

Medical Bill Audits/Reviews, which include meticulous, line-by-line bill reviews of inpatient and outpatient facility claims that concentrate on identifying numerous types of issues

History has proven that over 90% of medical claims have billing errors

Uncovering and defending against poor billing practices like unbundling, duplicate charges, coding and compliance, routine vs ancillary, and countless other issues requires a white glove approach.

Decades of experience in billing and coding, audits and appeals

History of over $200+ million in claims reviewed annually

Algorithms driven by CMS, AMA and FDA, and other supported guidelines

We are seeing a drastic increase in egregious billing practices by healthcare providers. Claim Solutions Negotiation and Medical Bill Review Teams have been making great progress in both fields for our clientele.

Our most popular services include;

Medical Bill Review/Audit – (MBR) a line-by-line review of in-patient and out-patient claims. We encourage the review of medical records when they are available. Our MBR algorithm and database is designed to outline categories such as; Routine vs Ancillary, Coding and Compliance and Clinical Concerns. All for one low fee structure.

Recently Claim Solutions reviewed 66 in-patient claims with an average billed amount of $759,257.58 and our MBRs have found an average of $145,421.19 in billing and coding errors, an average of 19.15%. Claim Solutions recommends these finding be subtracted from the providers billed charges prior to the application of any contracted PPO Network discount.

For example, if the above scenario was an actual claim with a 20% PPO discount:

Billed Charge Before Discount: $759,257.58

MBR Findings: $145,421.19

Allowable Before Any Discount: $613,836.39

Allowable After 20% PPO Disc: $491,069.11

Negotiated claim settlement

We offer expertise second-to-none in claim negotiation. Our unique approach will help your organization save money through in-network and out-of-network claim negotiations. Expertise in claims from hospitals, surgery centers, specialists, cancer centers, rehab centers, ambulance providers, and many others.

We are committed to helping your organization secure the maximum savings possible on all claim negotiations.

Negotiated Claim Settlements with Signed Agreements/Releases, as well as Continuous Discount Agreements

We handle specialty negotiations such as, dialysis, continuous care and pre-mature infants.

We also negotiate on patient claims while they are still receiving treatment.

PRICING SERVICES

Pricing and Repricing Services, which includes, but is not limited to, U&C/UCR, Medicare, Medicare-Plus, AWP pricing, or any form of Reference Based Pricing, taking into consideration the terms and provisions of the applicable plan documents and/or policies.

We specialize in Dialysis Claim repricing. However, we can provide our services on a variety of claims including, but not limited to In-patient and Out-patient facility, Ancillary, Physician, and Anesthesia Claims.

Our proprietary database is compiled of data from millions of claims incurred annually allowing us to review claims from billing providers and compare their billing rates with those of their competing providers within the same geographic region.

Our repricing services will help reduce our client's claims liability by identifying potential abuse, fraud, and egregious billing.

Dialysis Claim services

Underwriting and Risk Management

Medical Bill Review (MBR)

Don’t Pay Too Much For That In-Patient Confinement. Healthcare providers are charging more than ever for in-patient stays. Claim Solutions' Medical Bill Review (MBR) service identifies abuses in provider billing including; Coding and Compliance, Routine vs. Ancillary, Duplicate Charges, and Level of Care to name a few.

Consider the potential for increases in charges and more creative billing practices going forward, as providers/facilities attempt to recoup the losses from the lack of elective procedures during the lockdown.

Claim Solutions Can Help You Understand Complex Healthcare Claims

At Claim Solutions we are keeping a watch at the growing emergencies that our insurance payer friends will be facing in the coming months.

Claim Solutions, LLC

claim solutions innovative services

About Us

Our mission

Experience

Our hands on "White glove" approach

our client services

Medical Bill review

Negotiated claim settlement

PRICING SERVICES

Dialysis Claim services

Underwriting and Risk Management

Medical Bill Review (MBR)

Contact us

Request a pre-screen today

Claim Solutions, LLC