If you are a healthcare claims payer…

You are almost certainly a healthcare claims over-payer.

ClaimReturn can help fix that…at no cost to you.

The ClaimReturn Solution

ClaimReturn’s proprietary artificial intelligence platform reviews and analyzes your claims in a matter of minutes, sending up flags that our team inspects individually. Then we get fast to work on recovery. Our exclusive reporting system lets you follow our progress every step of the way. And ClaimReturn’s exhaustive analytics makes it easier to recognize future overpayments, making our recovery process both retroactive and proactive.

ClaimReturn Offerings

Post-Pay: After the claim is paid, we identify billing anomalies on a technical component and coding basis review across hundreds of logic statements within our rulesbased engine. We then recover those overpayments and return them to you.

Our Promises

COB: We identify claims whereby the plan paid, but Medicare should have in fact been the primary payer. We correct the payment ledger with Medicare as the payer and return the amounts you paid back to you.

To-Pay: After claim adjudication but before the bill has been paid, ClaimReturn provides a “final check” and makes payment recommendations preventing overpayment before any funds are sent to providers.

ClaimReturn’s collaborative approach to recovery is professional and respectful. We will never damage your provider relationships, your contracts or your own brand in the name of recovery.

We are not a collection service; we are a correction service.

We also promise full transparency in our process and analytics. We believe that the more you know, the more confident you’ll be in our work and proprietary systems.

Inaccurate claim payments are flying everywhere. We catch them.

Michael Loprieno Director of Analytics

Our next generation rating manual, Actuarial Advisor, allows you to swiftly price plans for groups of any size with or without historical claims experience while accounting for customizations such as reference-based pricing. Trained on billions of dollars in claims data, Actuarial Advisor is the most accurate rating manual on the market.