PGroup, LLC P  4 Automated Process for the recovery of small balance denied claims under $200 which most providers and collection agencies write off The P4P Group offers a proprietary service that augments hospital and physician group account receivable resources in order to recover small dollar high volume insurance claims   that are still outstanding and caught up in the health plan's claims adjudication process or have been wrongfully denied.  The P4P Group accomplishes this task by working through the compliance side of the health plan rather than the claims adjudication department. The company is highly successful at collecting these claims since the health plan’s appeals department is looking for information to substantiate paying the claim appropriately rather than the reason it was denied by the claims adjudication system.   The P4P Group’s experience in billing and collections shows that 70% of provider claim appeals are between $50-$499 and the expense to recover these small dollar high volume claims is costly after 60-90 days. This is an area where The P4P Group provides added value for hospitals and physician groups by collecting on these claims and allowing their accounts receivable resources to focus on newer higher dollar claims. One client  was able to recover $3.3 million of aged and written-off Inpatient and Outpatient claims over a 15 month period. They did this by pursuing these claims until they were either resolved or the entire claims appeals process was exhausted.  Why our service is different – Automated Appeals Process 1. Compliance vs. Claims Department  What makes our service different is the P4P Group works through the compliance side of the health plans rather than through their claims adjudication department. This is important because the claims adjudication department is where the claims were originally rejected. The claims   adjudication department usually does not have the authority to override their internal adjudication system, whereas the compliance and appeal side of the payer organization has the authority to override the claims adjudication department and PAY the claims. Most states’ regulations require the payers to respond to formal appeals- either pay them or tell the provider why they won’t pay them.  2.  Timely Appeals  All contracts with payers not only have a timely filing for the initial submission of claims, but also   filing time limit for the formal claims appeals.  The timeframes vary from as early as 60 days   after receipt of the EOB to as much as 180 days from the original claim.  Due to the manual nature of the typical follow up processes, almost ALL hospitals and collection agencies have a high dollar threshold for claims follow up, and in many cases allow the lower dollar, high volume   unpaid claims timeframes elapse, losing their right to appeal those claims, and subsequently writing off unpaid balances. 3. ALL Claims are Pursued  The P4P Group service promptly processes ALL denied, inappropriately paid claims or claims not paid. We submit the information in a standardized format to third party payers as a healthcare claim appeal.  The EZ Appeals system continues to pursue these claims until either resolved, or we have exhausted the appeals’ process.  Most internal and external solutions for accounts receivables’ follow up can only focus on high dollar/high priority claims as the payers are denying or not paying more claims than most providers can assign resources to follow-up. 4. Systematic “Patent Pending” Process  The P4P Group utilizes a proprietary patent pending eAppeals® processor your denied, underpaid, and unpaid claims. These databases include: • Submission and formatting mandates required by third party payers; • Submission locations for the more than 3,000 insurance plans; and their different levels of appeals • Escalation procedures and regulatory requirements for affirmed appeals. 5. Consulting Working with our clients’ data in its aggregate form allows us to identify and see issues and trends out clients, working with the data one claim at a time, often overlook.  We are able to offer consulting advice to our clients allowing them to improve the effectiveness and efficiency of their billing and collections processes. 6. Results Our process is proven.  We have collected over $50 million for our clients.  When combining our rebilling services with our appeals process our track record has been a 15% to 18% increase in accounts receivables collections over previous internal methods and outside contractors.   For More Information Contact: Steve Massey smassey@p4pgroup.com (423) 596-1700   || Home | Services | Contact | About Us | Healthcare Providers  | Healthcare Payers | Large Employers || Two Factor Authentication   High Security -Two factor = strong authentication -Two way = mutual authentication -Cognometric = personal authentication       User Convenience -No tokens to lose or forget -Fully mobile: use on any PC, iPhone etc. -Completely intuitive: works every time        Low Cost -Uses existing password infrastructure -No new servers or databases -Deploys in days –  not weeks           Contact Us  P4P Group is here to help. We know what it takes to be successful, and we stand behind our services. Please contact us for more information.