ERISA Recovery is committed to assisting provider’s teams with all difficult, time consuming and dead claim denials.
In return, revenues increase for our clients on their front end.
This improves productivity and increases the overall speed of reimbursement on all claim denials new and old.
ERISA Recovery is the leader in ERISA appeals.
Fewer than .005% of ALL appeals are appealed through the ERISA process.
See how the ERISA process will significally impact your bottom line!
Medicare ~ Medicaid Reimbursements
ERISA Recovery leads the industry with Medicare and Medicaid claim collections.
With our process, staff expertise and ERISA knowledge we can assure no revenue will be uncollected.
Treatment and Claims Recovery
Collecting claims and payments for hospital services can be extremely challenging. The number of employee man-hours and resources required to simply collect payments can be very costly. Complicating the process are various state and federal laws. Producing results means either exhaustive, brute-force efforts, or developing a better tool. Fortunately, we have made such a tool through the use of federal ERISA (Employee Retirement Income Security Act) law.
The Federal ERISA Law could be the most misunderstood law in the United States. Understanding the ERISA Law is crucial to being able to intelligently appeal and collect denied insurance claims as a patient advocate. Yet ERISA Law is not taught as a core subject in law school, and less than 2% of attorneys have ever even studied it as an elective.
As experts in this area, ERISA Recovery brings a wealth of knowledge and experience assisting hospitals in their negotiations with payors, insurance companies, and contract intermediaries. By properly applying this law, ERISA Recovery can help hospitals potentially deliver substantial portions of the contractual for any claim where the commercial insurance coverage was issued by an employer’s self-insured plan. (Government, church, and a few other minor categories are exempt).
We do all our work stateside and are contingency-based; There are no upfront fees for our services in the administrative appeal process. All fees paid to us are a percentage of new claims payments delivered directly to the hospital. There is absolutely no risk to the client hospital, and our payment is contingent on our client getting paid first. Our proven approach has been utilized successfully by hospitals and other providers all across the United States for over ten years.
Did You Know:
- The ERISA Law asserts that “anything less than 100% payment of the claim” is considered a healthcare claim denial, and is therefore eligible for appeal.
- All disputes, claims, and appeals over benefits paid under employer sponsored healthcare plans are bound by very specific ERISA procedures.
- While the Department of Insurance governs fully insured employee healthcare plans, the ERISA Law governs self-insured employee healthcare plans, which make up two thirds of all current health insurance coverage in the US. The “insurance company” is actually not the company that issues the policy; they simply provide administrative services as a claims processor, and they provide the PPO network.
- All contracts written by the network, PPO, HMO, etc. are superseded by the ERISA Law, as well as all state laws and all insurance company rules. Therefore, two thirds of all healthcare plans in the US are strictly bound by the federal ERISA Law.
- Any third party who administers claims and provides a PPO network is defined merely as an “agent” of the employer. This means the employer is still legally considered to be the fiduciary.
The ERISA Recovery Difference:
- Our claims recovery process acts as a virtual appeals department, providing an outside service that makes full use of the administrative appeal process defined by ERISA.
- Thanks to our highly trained and experienced recovery team, we’ve helped recover millions of dollars for providers across the US. Our rate of recovery ranges from 10% to 40% of previously written off denials on cases dating back to January, 2003.
- Our claims recovery services requires minimal involvement from hospital staff. Initiating our service takes only about three hours of setup time, and one hour per month for maintenance.
- Our service has been thoroughly vetted by multiple clients through law firms and state hospital associations, affirming all statements to be within ERISA federal law and procedures.