Managed Care/Commercial Insurance Representation

Healthcare providers are extremely efficient in resolving 85-90% of payor disputes. However, the constant influx of denials and other managed care issues allow the remaining unpaid accounts to lay dormant as they age or are transferred to a self-pay classification. Today, cash flow considerations require a healthcare provider to bill and timely conclude third-party receivables. SAC provides representation, advocacy, research/analysis, communication and consultation on all payor issues. Most unpaid accounts are due to billing errors or eligibility concerns such as:

• Erroneous pre-existing condition rejections
• Improper exclusion of benefits
• Wrongful denials of insurance - based on medical necessity, level of care, length of stay, coverage issues, et al.
• Improper contract interpretation
• Inappropriate payment determination for services rendered based on errors in interpreting contractual terms and conditions