Recapture Revenue with Payment Auditing

Payers make mistakes. It’s easy to do. Many services are reimbursed at fixed amounts rather than a percent of charges, such as DRGs, per diems, rates per case, lab or radiology and professional services fee schedules. The opportunities to make mistakes are great.

There’s also the confusing rock-paper-scissors hierarchy of payments, for example, rolling reimbursement for emergency department service into the outpatient surgery case rate if the patient is admitted for surgery from the ED.

Negotiating managed care contracts is just the beginning. Making sure you are paid according to the terms of the agreement is where you realize the benefits.

Managed Care Partners Helps Recover Underpayments

We will help you verify payment accuracy and timeliness. Our in-depth reviews accomplish two goals:

  • Identify claims where the payer’s allowed amount differs from the contracted rate
  • Compile the data necessary to appeal any payment errors

Our Payment Auditing Approach

At Managed Care Partners, we include verification analysis as part of our monthly fee for our clients.

We examine a sample of commercial claims and conduct an in-depth examination of those claims. In-depth reviews are based on a sample of charges over a specific time period, based on the number of payers, expected claims volume, fee structures within the payer contracts and the availability of electronic claims data files from the provider.

Strengthen Your Financial Performance

Getting paid according to the terms you negotiated may make or break your profitability. Let Managed Care Partners help you ensure you’re paid according to the terms of your agreements.

Managed Care Partners teams with critical access hospitals, small rural hospitals, and physician groups to create superior managed care financial performance.


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Managed Care Partners, Inc.
875 N. Addison Avenue
Suite 200
Elmhurst, IL 60126

630.936.4211 - phone

630.617.4222 - fax