Med-Enterprise Process for Prompt Pay Claims Recovery


After any initial meetings between Med-Enterprise and the client’s team about what the process entails, there are three main stages in the actual process to identify, validate and resolve “missing or otherwise lost” revenue within your Prompt Pay Claims system: 1) Process Orientation, 2) Data Analysis and Claims Assessment and 3) Validation and Recovery.

1)   Process Orientation

The first stage of the process begins with the in-person meeting with the financial leadership of the provider organization. At this meeting, we discuss the process to come and begin to technically ACCESS the billing data collection so that we can ASSESS the data for functionality and review the managed care contracts.

2)   Data Analysis and Claims Assessment

We then INITIATE the data mining and begin the CIRCA℠ Process. Our first analysis of the data produces the needs assessment SUMMARY, giving us our first glance at the potentially new-found revenue.

3)   Validation and Recovery

Once the data has been analyzed and an agreement as to the value of the find is determined, the process shifts into validation and recovery. We PREPARE value-added reports and DECIDE on the best revenue pursuit strategy using your Business Contracts and state Prompt Pay Statute. Together we PRESENT our findings to the payer’s team and prepare for the litigation process. Finally, we then RECEIVE the reconciled revenues from settlement or award.

Remember: ALL of the above work is performed on a contingency basis with no direct cost to our clients.