What is Claim Recovery?
Health Decisions’ Claim Recovery Services combine technology and human skills to identify claims paid by the client that should have been paid by someone else. Once these claims are identified, Health Decisions pursues the collection of payments until the moneys are returned to the client.

We routinely audit our health plans. Why do we need Claim Recovery?
Claim Recovery is an audit with a difference.

• An audit is based on a claim sample with a sampling error of 3-5%; Claim Recovery reviews 100% of paid claims and finds recoveries that sampling would miss.
• An audit uses only existing information; Claim Recovery finds new facts and data to increase Claim Recovery.
• An audit is intended to assess administrative performance. Health Decisions does that plus we recover your money.
• An audit issues a report of findings; Claim Recovery produces a detailed accounting of specific claims to be collected and makes sure recoveries are received.

Why do we need Claim Recovery? Doesn’t my claims administrator do this?
The typical health claims administrator does perform some Claim Recovery, but not in a way that is comparable to Health Decisions Claim Recovery services. The typical claims administrator monitors only about one-fourth of the Claim Recovery areas that Health Decisions pursues. Even when an administrator does look for Claim Recovery, it is not the main focus of activity. All administrators must limit Claim Recovery identification and pursuit to keep their fees competitive. Most claims administrators do a professional job of claim payment. However, even the best claims administrator cannot perform Claim Recovery as completely as Health Decisions does. Health Decisions helps its clients identify and pursue all claim opportunities.

Does Claim Recovery work for all plans?
Yes. Any plan that can access its paid claims data and has most or all of its plan costs based on actual claim levels can benefit.

There are other recovery firms; why is Health Decisions different?
There are firms that perform some types of recovery, such as Medicare disability or subrogation. But none of these firms encompass the full range of recovery opportunities offered by Health Decisions. By having us perform a full range of recovery reviews, clients maximize the amount of potential recovery and minimize their time spent monitoring these activities.

Because we have been in business since 1985, Health Decisions is the most experienced independent Claim Recovery firm in the United States. That experience, coupled with our edge in technology, will save you time and money.

You claim to be at the cutting edge of technology. What is this technology?
Our Universal Translator (UT) takes computer files from any source and translates them to common forms and formats. Annually Health Decisions translates more than$1 billion in claim payments in dozens of different data formats. The UT anticipated the data clearinghouse role contained in the new HIPAA privacy regulations by several years.

Our Enrollee Communications Support (ECS) combines existing information on individuals from various sources to produce a complete personal profile that provides a basis for several reconciliation, auditing and verification tasks. Health Decisions annually process more than 250,000 such communications.

Our Paperless Case Review (PCR) combines new claim recovery opportunities with a fully automated collection, tracking, accounting and reporting system. Each year Health Decisions finds millions of dollars in recoveries for our clients using PCR technology.

In addition, our accelerated RAM and vast storage capacities allow us to process and store vast amounts of information in huge databases.

What type of security do you offer for electronic transmissions?
That’s a good question because sending documents and files via e-mail attachments is becoming more of a hassle than help. Over one-fourth of all e-mails never reach their intended recipient because of firewalls, spam filters and the growing tendency of people to delete files with attachments to prevent viruses, pop-ups and hackers. For sending sensitive, confidential documents, this situation is unacceptable and downright dangerous.

Health Decisions developed SecureX for the transfer of files with personal health information to meet all federal security and private requirements. Our SecureX security protection replaces ground couriers and e-mail for the transfer of confidential electronic files. Files are uploaded directly from your local computer and transferred for download directly to a recipient’s computer. Password protection prevents unauthorized access and e-mails confirming the sending and receipt of files provides a full trail of documentation.

How much money are we likely to recover?
A rough gauge of recovery potential is 1-3% of annual paid claims. The actual level of recovery will vary by client. For example, one large Medicare recovery can dramatically affect recovery results. Many clients, however, achieve future cost savings from our auditing process than they do in claims recovery.