Michaele Pimentel
Baltimore Area - Director Operations at eReceivables INC - Coral Springs, Florida, United States
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eReceivables INC
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Our patented Small Balance Claim Recovery service is a system which methodically and systematically appeals claims that have been underpaid, denied, or never acknowledged via an automated process by applying a proprietary method utilizing rules, laws, intellectual logic, and our demographic database. By standardizing the appeal, we take a mass production approach to the smaller balance claims' problem and bring scale to the processing efficiencies. Our proprietary solution has a proven record for over 15 years!One client sent us 37,500 claims on Monday, and they were all appealed within days!Every 60 days, we escalate the appeal, till the claims is resolved.Uniquely, we work through both the appeals and the compliance side of the health plans rather than through the claims department. This is critical because the claims department is where the claim was denied or paid inappropriately initially. The compliance/appeal side of the payer organization has a different set of rules with which to comply, and they have authority to override the claims adjudication and PAY the claim. Utilizing our proprietary database of over 3,000-payer appeal and escalation addresses, our systematic escalation process gets the claims to appropriate management levels within the payers' organization so claims can be properly processed, not just recycled in the payers' claims systems that did not result in a payment initially.