RevOne Companies utilizes our denial management solution to support denial/rejection/appeal follow up, as well as highlights payer trends. Our team of in-house attorneys will help you not only receive payment on these denials, but will also search for underpaid claims that will maximize the overall payment you receive.
RevOne is different from other companies because we pursue payment on these denials utilizing ERISA, as well as health insurance contractual appeals. Employee Retirement Income Security Act of 1974 (ERISA) is the primary federal law governing claim disputes involving health insurance obtained through a patient’s employer.
ERISA is a powerful legal tool to use when an adverse benefit determination is made and an employer-sponsored health plan is involved. ERISA governs the majority of non-Medicare claims and covers every employer-sponsored health plan in the private sector. ERISA does not govern any non-private governmental plans, Medicare, worker’s compensation, plans sponsored by religious organizations, individual polices and/or personal injury claims.
In addition to pursuing health insurance contractual appeals, RevOne Companies and our eight in-house attorneys will maximize recovery by pursuing ERISA appeals on a concurrent basis. We provide a dual approach to obtaining payment after an adverse benefit determination has been made.
We will request the documents that govern the administration of the ERISA plan, interpret these documents, verify whether the adverse benefit determination was correct, and appeal any adverse benefit determination that does not strictly abide by the terms of the plan document. We can even review health insurance contractual denials to determine if an appeal is available under the terms of the contract or ERISA. RevOne Companies will diligently pursue all appeals to ensure that all applicable laws and regulations are used in a way that provides you with the highest recovery possible.