Healthcare service providers face increasing financial risk due to the expected increase in uncompensated or undercompensated care resulting from the rollback of the ACA’s Individual Mandate and escalating consumer medical debt. Meanwhile, employers, and commercial and public payers are seeking solutions to offset escalating medical and pharmacy benefit claims to optimize financial performance and improve the plan’s underwriting profile. Optimization of third-party liability (TPL) recovery in traditional revenue verticals and development of recovery avenues in non-traditional, litigation-related verticals can mitigate financial risk for all stakeholders.
Our highly scalable technology platform mines billions of dollars of written-off provider accounts receivables and associated clinical encounter data to identify recovery opportunities for which a third-party payer is responsible so that stakeholders can reduce their medical loss ratio and offset their medical spend for health plans. While practical complexities in traditional revenue-recovery verticals and information-lag and litigation complexities in legal verticals have prevented providers and payers from recouping against high-dollar opportunities, Allēus has developed business intelligence and outsourcing solutions to maximize recovery across traditional and non-traditional verticals alike.
Our comprehensive, gap, and opportunity analyses of current state/actual versus expected recovery performance related to TPL provide an objective and reliable review of existing recovery systems and identify previously undetected or underutilized opportunities. Our exclusive business intelligence database and proprietary algorithms optimize identification and qualification of viable third-party revenue recovery pursuits.
SUBROGATION: AVENUES TO RECOVERY
Property & Casualty Insurance:
- We search available databases to identify fact-patterns in which a patient is most likely to file an insurance claim against his or her insurance policy or that of a third party as the result of a property or casualty loss incident.
Personal Injury Litigation:
- We use real-time data to match lawsuits involving patients who are injured by the actions of a third party and who file suit against the third party seeking compensation for their injuries.
- We analyze and match third-party recovery rights for insurance companies pertaining to medical claims by employees who sustain injuries on the job.
Car Accidents in No-Fault State:
- We search available databases to identify opportunities for insurers to claim recovery rights for property damage and medical claims resulting from car accidents in No-Fault states.
- We perform a highly sophisticated recovery analysis across the complex U.S. litigation landscape to identify high-dollar, high-probability recoveries among the dozens of defective drug and device Mass Tort litigation dockets around the country.
Our highly automated business process operations ensure the timely and successful recovery of legally owed funds. Upon client request and authorization, we can work collaboratively with existing plan administrators or vendors to enhance recovery returns, or we can provide direct recovery support for newly identified or previously undetected cases not under current management.
Lien Perfection & Subrogation Recovery:
- If desired, we can deploy our TPL recovery expertise and perfect the lien for the provider and pursue subrogation recovery for payers to completion.
Patient Advocacy & Outreach:
- When authorized by a client, we provide sensitive, HIPAA-compliant and patient-centered outreach services to help patients find new solutions to satisfy their outstanding medical debt at no additional cost.
- Our clients remain in full control of the communication tools and messaging we use in their projects.
- We are not a medical debt collection agency.
- There are never any hidden costs to patients.
- Our experienced call center team members do not seek to recover any funds directly from patients.