CLAIMS PROTECTION

when 1 in 5 claims are wrong make sure your

employees don't pay the price

LEARN MORE

IT'S FRIENDLY

WHEN YOUR EMPLOYEES HAVE CLAIMS ISSUES

Who can employees turn to when their claims are incorrect? Or merely confusing? HR doesn't have the bandwidth or access to review the issue. Most brokers refuse to get involved in claims. Don't leave your employees stranded without help, let our Certified Claims Auditors review and fix any errors.

Cofactor

is here for them

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STEP 1

IT'S FAST

WHEN YOUR EMPLOYEES HAVE CLAIMS ISSUES

When employees experience a claim issue they simply upload the EOB, receipt, or visit details and our team of Advocates get to work immediately. With the help of our proprietary algorithm, the advocate will ensure the medical codes used were correct, that the insurance was applied correctly and that the

Cofactor

gets to work quickly

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STEP 2

IT WORKS

WHEN YOUR EMPLOYEES HAVE CLAIMS ISSUES

Our advocates stay in the fight until all parties have accurately processed and adjudicated the claims. This includes negotiating down any balances due to out of network providers. In simple terms, Cofactor just works!

Cofactor

fixes the issue

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STEP 1

OF ALL MEDICAL CLAIMS

ARE PROCESSED INCORRECTLY

WHO WILL YOUR EMPLOYEES TURN TO FOR HELP?

HR?

HR Professionals are heroes, but they don’t have the bandwidth to help employees with their claims. Nor should they enter into the liability of processing claims.

INSURANCE CARRIERS?

The Insurance Carriers almost always profit from these errors. They have no vested interest in improving the accuracy of their claims department. On top of that, carriers are antiquated and confusing.

THE EMPLOYEES?

Medical codes, insurance complexities, nuances of their plan – these are all impediments keeping employees from being able to understand and review their own claims.

WE CAN HELP!

We Verify Medical Codes

The codes used for billing have a tremendous impact on how a claim is processed. There could be several codes for the same procedure, though some are more expensive than the others. We ensure the correct codes were used – and verify that they match the type of service the employee went in for.

We Verify The Insurance

The insurance carriers don’t have a hard-coded system that automatically applies the correct benefits to a claim. This allows for human error and explains why 20% are incorrect. We verify the plan benefits were applied correctly to the claim and request a change if they weren’t.

We Coordinate Between Everyone

Verifying claim accuracy is a human task. We use a proprietary algorithm to get the process started, but we have to speak to the insurance carrier, to the provider’s office and to the employee to ensure accuracy. We handle it with experience and persistence and wrap it all up under advanced HIPAA security – so your employees’ information is safe.

COFACTOR FEATURES:

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

Over 10% 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.

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 machine learning and other technology to execute our claims advocacy, behind each and every claim is an expert Claims Advocate. 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.

Get In Touch To Learn More!

© 2019 Quantum Insurance Services