Overview

The client, a mid-sized academic health system based in California, sought a partner to calculate expected reimbursements for all third-party payers based on their respective terms and conditions. PCH Health implemented retrospective underpayment identification and recovery services, providing extensive standard and customized reporting packages.

Challenges

• Calculating expected reimbursement for all third-party payers
• Independently identifying and recovering additional reimbursements rightfully & contractually due
• Modeling all third-party contractual agreements
• Predicting & responding to expected reimbursement for new & renegotiable agreements
• Collecting identified underpayments