Claims Management Solutions

Ott Cone & Redpath knows that it is all too common for third party payors to employ abusive practices designed to avoid payment of valid claims, including payment delays, erroneous claim denials and underpayments. These legally impermissible tactics can have a significant negative impact on medical providers' revenue stream.

With over 30 years of experience in working with providers and in-depth knowledge of the federal and state laws and regulations, as well as contractual obligations that apply to claim disputes, our professionals have developed very effective and cost efficient strategies to help providers assert their legal rights against recalcitrant payors and receive proper and timely payment of claims.

Our customized claims management solutions include handling appeals of complex insurance coverage cases, ensuring payor compliance with legal requirements governing provider reimbursement and providing training to hospital staff of laws applicable to third party payors. Providers have found our solutions to be a cost-effective means to increase revenue and, in many cases, eliminate unlawful practices by third party payors.

Claims management solutions address:

  • Billing and Coding Issues
  • Commercial Insurance Plans
  • Discount Brokers
  • ERISA Insurance Plans
  • Government Payors (Medicaid, Medicare, Tricare, and Veteran’s Affairs)
  • Managed Care
  • Third Party Liability
  • Workers’ Compensation

Self-pay Collections

Often times, healthcare providers are confronted with issues while seeking payment from patients and may not fully understand laws and regulations applicable to collection involving patients and their spouses, minor patients and their parents, out of state patients, patient estates and guardians, and statute of limitations issues. Ott Cone & Redpath has a wealth of experience in handling complex collection matters against legally responsible parties that consistently produce favorable results.