An experienced team of clinical and denial specialists will investigate your case to find the reason it was denied and provide the necessary actions and documentation to have the decision overturned. UR Solutions is committed to helping inpatient and outpatient healthcare providers through the denials and appeals process to ensure optimal reimbursement for all services rendered.
Emergency Department Underpayment
Underpayments happen more often than you would think, with as many as one in four hospital bills being underpaid. Often, emergency room bills are the ones undercut. Our team of experts will investigate why bills were not fully paid, identify patterns to streamline the billing process and take steps to resubmit to receive optimal reimbursement.
We offer Actuarial Services to all of our clients. Our experts carefully review all data using robust data mining and screening techniques. We then organize these key performance indicators into weekly reports for our clients. These reports, which include recommendations, have helped our clients significantly increase efficiency and cash flow.
Our highly trained registered nurses are experts with years of training and experience in Medicaid appeals. Our familiarity with Medicaid’s regulations and criteria, as well as our clinical expertise and careful examination of medical records, makes us uniquely qualified to dispute these denials and allows us to provide increased revenue for our clients.
Legal (3rd) Level Appeals
Once we file an appeal, our legal and medical team works diligently and aggressively to obtain an overturn at all costs. Our medical team examines each administrative denial and, utilizing its extensive experience, fights to receive an overturn by means of third level appeals. During this process, our legal team examines and applies all pertinent state and federal laws in order to ensure the receipt of an overturn and the recovery of important funds.
The UR Solutions team includes board-certified physicians that can review cases to determine claim, legal and malpractice viability and provide additional advisement.