Situation
A large regional physician organization based in Tennessee with providers throughout the region and a broad payer mix was concerned about potential exposure under the Independent Dispute Resolution (IDR) process—and possible reimbursement loss across its portfolio.
Solution
Seeking an expert review, the group referred more than 34,000 cases to us for analysis. That review found potential in more than 18,000 of the claims at 2.67 times the Qualifying Payment Amount (QPA), the benchmark payers use to set their initial offer, for average requested allowable.
In addition, our findings were well researched, documented and in line with IDR guidelines, giving the customer confidence that they were working within policy. Aligned with the customer, we immediately began the dispute process.
Results
Following a 100% quality control and assurance process for the disputes, we worked on behalf of the customer to win more than 91% of the disputes and recover $3.6M through this exercise.
34,807
cases referred
91.10%
our win ratio
$3.6M
increased net cashflow to customer
