Claims Recovery

PYA takes a unique and proactive approach to Claims Overpayment Recovery Services. Through our assessment process, we will not only identify claim errors but also offer solutions to prevent claim overpayments.

The key to our success is our unique approach in identifying claims overpayments combined with our ability to correct “root” causes of errors. Such errors occur due to the complexity of the industry, retro-activity of eligibility and contracts, and inconsistent and inaccurate claims payment processes. While the industry standard is to conduct sample audits and address “cleaning things up” downstream, we analyze entire claims data sets and reverse engineer results to identify and isolate the problem in the first place.

Data Analysis is Critical. It all starts with acquiring a file of your organization's paid claims. Our experienced professionals bring backgrounds from various components of the claims payment process. As such, we have years of experience and understand where to look for the types of things that plague the industry as a whole. But, with detailed data mining, constantly comparing and contrasting your data against and to itself, we are able to identify issues that are often unique to you and your particular claims adjudication processes. This approach allows for detailed claim level reporting, not extrapolation or projections based on a best guess. Our approach produces the detail necessary to truly identify and prioritize issues affecting your bottom line.

The incentive for PYA is to bring value to our clients immediately, not return year after year to profit from issues costing you money. By attacking the issues at the source, we believe we deliver the most effective methodology to increase the client's profitability. We believe the best recovery is the one avoided.

PYA offers a wide array of services to the health insurance industry. Many of these services can be priced on a risk-free contingency basis. That means you pay only for actual results, monies returned to your bank accounts, not promises or projections based on questionable assumptions. That means you get your money first.

Services Offered:

• Managed Care
• Claims Recovery
• Operational Assessments
• Financial Turnaround and State Compliance
• Health Plan Liquidation Assistance
• Network and Fee Schedule Analysis
• IBNR Reserve Studies