According to most estimates, over 10% of U.S. medical claims are paid incorrectly due to discrepancies. On top of that, another 15% of medical insurance claims go unfulfilled because of segmented follow-ups. This, in turn, leads to higher costs and more governance-related issues for healthcare providers.
As experts in health insurance recovery, Mbsap enables you to gain focus on your bottom-line by fighting fraud, waste, and reduced fees. Armed with the expertise, tools, and resources which you require, we help to maximize recovery through our supplemental insurance collection services.


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    What is Health Insurance Recovery?

    At Mbsap, HIRS or health insurance recovery services are a part of our extended suite of medical insurance services for global clients. Our HIRS system is based on a flexible model that can be customized based on every client’s requirement. Our accounts receivable follow-up solutions ensure complete resolution including payer liability confirmation and collection, along with the identification of unrealized payments in the form of adjustments and contracts. Some of the most common reasons for unpaid claims which we help you recover include –

    • Patient Demography Errors
    • Insurance Writing Errors
    • Medical Coding And Coverage-Related Issues
    • Payer Processing-Related Issues
    • Delays Caused By Carriers

    We work with an in-house team of experienced and trained personnel who are swift to address denials and unpaid insurance amounts thereby accelerating your cash flow while reducing the total number of write-offs each quarter. This directly leads to better billing cycle management.

    Our Health Insurance Recovery Services

    From our experience, we have seen that health insurance recovery solutions can take on different forms, based on the exact nature of your business. By leveraging our proprietary tools, technology, and the expertise of our health insurance recovery service providing company experts, we help to reduce costs and increase the volume of recoveries. Our health insurance recovery services include –

    Medical Subrogation Recovery Services

    As your health insurance recovery service provider, we leverage our technology and experience to recover unpaid amounts for our clients. Our in-depth investigation process recognizes potential sources of recovery including –

    • Motor vehicle accident liabilities
    • Product and equipment-related liabilities
    • Location and premises liabilities
    • Medical malpractice liabilities

    Once identified, we work closely with your legal staff to assert your rights and achieve the best possible settlement.

    Overpayment Recovery Services

    We help to find out all overpayment-related issues plaguing your service and help to reduce payment leakage for better client satisfaction. We aim to identify and recover all the benefits paid where either Medicare or any other payer should have paid the primary amount. This information is then shared with you to ensure accurate payments can then be made.

    Accurate Reporting

    One of the primary challenges for health plans which directly feed medical information to Medicare is to look beyond Section 111 compliance. At Mbsap, we ensure we provide the correct entitlement data to directly reduce Medicare’s or any other provider’s potential for overpayment thereby boosting the risk involved for you. We offer –

    • Timely and accurate determinations
    • Regular updates to a common working file
    • Maintenance of medical primacy records
    • Accurate MSP and non-MSP reporting

    Secondary Payer Validation

    When you are Mbsap healthcare recovery services, you need a partner who can go through your list of Medicare Advantage payers and check for other commercial insurance coverage. This is because it allows you to validate the data and ensure the primary payer is listed correctly. This directly ensures you can receive accurate and higher premiums if the health plan is the primary payer.

    Pharmacy Audits and Compliance

    We offer an extremely flexible and scalable pharmacy auditing service which is of exceptional use to our clients. We leverage our in-depth data analytics functions to score pharmacies and perform prescription claim reviews to identify where the losses are being generated from. We help to mitigate risk, and include –

    • Retail pharmacy audits
    • Pharmacy claim check
    • LTC-related audits
    • Mail-order drug audits
    • Invoice audits
    • FWA audits
    • Drug audits
    • Pre and post network credentialing audits

    Specialty Medical Audits

    We are one of the few healthcare recovery services in India that cover specialty requirements such as durable medical equipment audits, home infusion therapy audits, high-cost drug audits, etc. Our auditing process has been fine-tuned over the ages and leverages our proprietary software to focus on compliance and overpayment drivers within these areas.

    Dependent Eligibility Audits

    Over the years, we have seen that many health plans carry ineligible dependents who directly increase the cost of care. Our experienced team audits multiple groups such as fulltime students, domestic partners, common-law spouses, adoptions, and other potentially ineligible dependents – to validate membership through school records, birth certificates, and other forms of identification. Then we help you remove ineligible dependents from your membership rolls and recover any paid claims on your behalf.

    Medical Credit Balance Audits

    As part of our health insurance recovery services, we can recover duplicate claim overpayments, payments that are outside of the stipulated contracts, and other COB errors. We ensure all credit balances are recovered on time so as to ensure better cash flow.