Health Payer Recoveries – Insurance Services

Insurance companies within the health industries process billions of claims involving medical codes and terminology unique to the industry. These claims must be assessed against each policy, which also vary dramatically. RMS offers qualified and trained industry personnel and processes capable of either supporting your staff or completely managing and administering the processing of these claims.

What We Do

RMS services 9 of the top 12 health insurance companies! We provide the depth of industry knowledge and recovery expertise to investigate the situation efficiently and substantiate the facts. As a first or third party administrator (TPA), we will then clearly explain the details of the situation to the parties involved so that payment can then be made and the situation resolved. Our areas of expertise in regard to Health Payer Services include:

HIPAA Privacy Rule

RMS complies with all contractual obligations recommended or required by Health & Human Services for Business Associate Agreements under the HIPAA Privacy Rule.

  • Provider-Member Overpayments – Overpayments are a common error within the insurance industry costing millions of dollars annually. RMS will investigate the situation in a timely manner, document the facts and proceed to collect any overpaid funds to resolve the situation.
  • Group Grace Period Recoveries - RMS will verify and document that payments have been made within the limits of the grace period set forth in the insurance policy. If premium payments exceeded the grace period we will work with the insurer in resolving the situation by making notification and collecting penalties necessary to re-instate or maintain the policy.
  • Retro-Term Pharmacy – When the termination of an employee is not immediately communicated to the insurance carrier, benefits such as for medications, may be paid out in error. RMS can work with the insurer to investigate, notify and collect these payments.
  • Overpayment Disability Claim Recovery – Disability coverage and payments fall within a specific category of policies. Overpayments made against these claims can cost insurance carriers millions of dollars annually. RMS can investigate the situation in a timely manner, document the facts and then proceed to collect any overpaid funds.