THE ULTIMATE CLAIMS REVIEW SOLUTION FOR

BUSINESS MANAGEMENT FIRMS

We are the next evolution of claims advocacy for business management firms. Powerful. Secure.
That's Cofactor.

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Claim Review

EXPERT REVIEW OF MEDICAL CODES & INSURANCE PAYMENTS

Once a new claim is submitted our team begins gathering all the needed information. We verify the medical codes used in the claim to ensure it was billed correctly. We then either submit to the insurance, or verify it was processed correctly.

Advocacy

EXPERIENCED CERTIFIED CLAIMS AUDITORS GUIDE YOU ALL THE WAY

Claims review requires an actual person to sift through the data and liaise between the provider and the insurance carrier. Our reps are all certified claims auditors with extensive experience reviewing and fixing claims.

As business managers you need to be able to provide reports of all claims for a client within a set time period. In addition, our portal allows different levels of access for different employees, keeping your client's info private and safe.

FROM RUNNING CLIENT REPORTS TO SAVING MONEY, WE GET IT DONE

Results

BUSINESS MANAGEMENT CORE FEATURES

Cofactor was designed with the input from some of the biggest business managers in the industry. We tailored the interface, the fields, the process and the reporting to be easy to understand but more importantly as useful as possible.

SUBMITTING CLAIMS

We have a long history of working with business management firms and we understand their clientele. You may not always have an EOB to verify, that’s why you can submit an EOB, an invoice, a credit card receipt or even just tell us a provider’s name and the date your client had service – we’ll take it from there. From requesting an accounting of the visit, submitting to the insurance and even negotiating down any balance due for out of network providers. We make it easy on you and your clients to ensure they are maximizing their insurance and saving as much money as possible.

CLAIMS ACCURACY

Much like financial accounting, medical coding and reimbursement has a complex set of rules that can lead to varied interpretations, and unintentional oversights. Medical providers bill claims to maximize revenue. Third party administrators and insurance carrier process claims efficiently, but incur additional costs or risk abrading providers when they stop payment. So mistakes and overpayments happen. Cofactor utilizes a proprietary set of algorithms to identify errors and oversights and make sure you don’t end up paying for them.

INSURANCE PAYMENT CONFIRMATION

20% of all claims processed by insurance carriers are incorrect. The errors could rest with the claims processor or the provider’s office. We first ensure the medical codes are accurate, then we verify the claim was paid per the benefits of the claimant’s plan. Once we confirm everything is accurate we let you know the status.

OUT OF NETWORK CHARGES NEGOTIATION

Whether on purpose or accident, sometimes the insured finds they went to an out of network provider. If your insurance covered the claim at all depends on your benefits. However, even if it is covered, the out of network provider can balance bill you – or charge you anything they want for their services. Cofactor steps in and negotiates down in remaining balance due. Our deep knowledge of insurance allows us to determine a fair price and often when paying a claim yourself, providers allow deep discounts.

CLIENT REPORTING

Clients require claims reports for taxes, for hardcopy updates or just for peace of mind. We’ve built reporting into Cofactor, allowing managers to run reports based on a client, a family, a provider, an account manager, or the entire firm’s clients. Specify a date range or list all claims and status. You can view reports online or download PDF versions.

FULLY HIPAA COMPLIANT SERVERS

Client privacy is not only paramount when dealing with Private Health Information (PHI), it’s the law. We are the only claims advocacy service offering true HIPAA compliance security from start to finish. We deal with some of the biggest names in the world, and we take the protection of their information seriously.

SECURE AND HIPAA COMPLIANT PORTAL ACCESS

In addition to our HIPAA compliant servers, we also have the highest level of security on our portal. From start to finish feel confident that your information is safe with us.

EXPERT SUPPORT FROM CLAIMS ADVOCATES

While we utilize advanced algorithms to execute our claims advocacy, behind each and every claim is an expert Certified Claims Auditor. Our advocates are trained in the fine art of persistence when working on claims. They deal directly with the provider’s office to obtain information and confirm claims were submitted correctly. They also spend extra time explaining everything so that you know what actually is going on with your claims.

BACKED BY QUANTUM POWER

QUANTUM + COFACTOR

Signing up for Cofactor also brings the benefit of working with Quantum to handle the firm's and its clients' needs. Together we provide a level of care you've never experienced before.

EXPERT BROKERS

Quantum started in the employee benefits space. We formed during the launch of the Affordable Care Act with the mission of providing true expert guidance during these chaotic times. Additionally, we provide a host of resources for our clients, from HR, payroll, commercial and professional liability and of course white-glove award-winning service.

WE UNDERSTAND YOUR CLIENTELE

We have extensive experience servicing business management clients, especially those in the entertainment space. We understand the speed and accuracy needed when handling client policies. We are your backup to ensure nothing goes wrong, or to fix the inevitable issues that arrises with anyone's insurance.

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