Complex claims

Complex claims, simplified.

Recover hidden dollars faster with expert-led, tech-enabled support that accelerates complex claims reimbursement.

Speak with an expert

Scale and experience drive results

$2.3B

in recoveries for clients in the past 24 months

10-15%

increase in cash flow

20%

decrease in days in AR

R1 offers a comprehensive solution of expert-driven offerings to accelerate reimbursement for the most complex claims.

( 1 )

Motor Vehicle Accident (MVA/TPL)

Expert clinicians and in-house legal team use industry-leading tech and settlement protocols to maximize recoveries.

( 2 )

Worker’s Compensation Optimization

Our specialists and legal team pursue every dollar from auth to submission to battling medical and legal arguments.

( 3 )

Veteran Affairs Claim Management

Experts use modern tech to navigate complex VA rules, ensuring accurate routing and driving timely reimbursement.

( 4 )

Out-of-State Medicaid (OoS)

Our team manages provider enrollment to optimize returns for all 50 states.

R1 streamlines the clinical appeals process with AI-assisted automation

Appeals process

Traditional

R1 AI-assisted appeals

Finding opportunity

Traditional

Lengthy manual review

R1 AI-assisted appeals

AI triage agent segments data and gathers needed documentation

Draft the appeal

Traditional

Manual, up to 1 hour

R1 AI-assisted appeals

AI drafts the appeal, reducing time by 50% to just 20 minutes

Validation

Traditional

Manual research/revision

R1 AI-assisted appeals

Clinician-in-the-loop performs QA and drafts any changes

Submission

Traditional

Acquired experience

R1 AI-assisted appeals

Payer intelligence selects the best path, format and payer-specific data to streamline submission

Follow-up

Traditional

Manual calls or checks

R1 AI-assisted appeals

Autonomous follow-up

Case Study

Doubling VA/Military Revenue for Multi-State Health System

R1 helped a large, multi-state healthcare system double their VA/military monthly revenue from 1.6 million to 3.2 million using our Complex Claims technology and R1 Acceleration Suite.

Healthcare technology team member analyzing data visualization dashboards for operational insights.

Autonomous follow-up for back-end revenue cycle performance

Part of Phare Flow

Phare Flow doesn’t just follow up—it follows through. From claim submission until payment, intelligent agents work as a team alongside humans to manage claim status checks, denials, escalations, credits and adjustments at scale. R1 brings unmatched payer connectivity, data and influence to help drive open AR down to zero.

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Differentiators

Experts collaborate with AI agents to accelerate complex claim recovery

Expert claim review

R1 provides dedicated teams for each claim category.

Find more coverage

Proprietary Insurance Discovery platform sharpens CoBs and accelerates revenue.

Precision and speed

Strategic clearinghouse partnerships expedite implementations and ensure accuracy.

AI-assisted agility

AI-assisted monitoring of federal, state, and local laws and regulations.

Meet our experts

Kate Knitter

SVP, Operations

Derek Shaw

VP, Operations

Solution

Learn more about Complex Claims

Healthcare technology professionals reviewing digital health data and analytics on a laptop.

Solution overview

See how R1 blends specialized expertise, cutting edge technology and scaled experience to unlock revenue, reduce friction and free your teams to focus on higher-return claims.

Learn more