First Day Billing

We electronically transfer claim information (demographics, procedure codes, etc.) in real time to our billing system.  Our claims processors immediately analyze the claim thoroughly to determine any missing and/or incorrect information, and then initiate the appropriate efforts to request, research, and fix all necessary data elements.  After the claim has been scrubbed to produce a completely "clean" claim, we generate a UB, CMS-1500, or 837 and mail or transmit it to the appropriate payor.  ARMS never sends out a claim until we are certain it will not be rejected.

After claim submission, we perform frequent follow-up to ensure that claims are processed and paid in a timely manner by the payor.  We also respond to payor requests and inquiries in a timely manner,  and bill secondary or tertiary payors consistent with state regulations.

Our billing team continues their tenacious efforts to effectuate payment for up to 60-90 days or until there is a denial, whichever comes first.  We will forward the account to our Collections department only if payment is delayed beyond 60-90 days, or is denied at any point for various reasons such as SIU (Special Investigations Unit), IME (Independent Medical Exam), Record Review, No PIP Application, etc.
 

Collections

Our expert Collections team has a unique and sophisticated arsenal of tools that allows them to consistently recover payment from insurers for referred claims, even when dealing with the toughest claims and most difficult insurers.  The ARMS collection service deals exclusively with insurers to obtain payment from them, we do not contact patients for payment.

Every member of the team has many years of experience in the collections process for these specialized third party liability claims.  The senior members have an extensive background in the industry and have worked "on the other side" for payors, which is a key advantage in figuring out what strategies work best and in establishing credibility with and respect from payors.

Denied or delayed claims are analyzed in detail to determine the optimal strategy for timely resolution and payment.  We have vast experience and success with every type of denial or delay employed by payors, including incomplete/missing documentation, medical necessity issues, IMEs, Record Reviews, Usual and Customary reductions (UCR), EUOs, No PIP Application, and patient non-cooperation issues.

Our team is incredibly tenacious and resourceful, and do not relent until all possible efforts and payment sources have been exhausted.  We pursue the responsible PIP or Workers' Comp carrier, health insurance (including Medicare and Medicaid), BI (Bodily Injury) carrier, Patient Attorney, MedPay, ERISA plans, etc.  We never pursue the patient for payment, we only contact the patient, when necessary, for information that will help us pursue the insurers.  We use the DIA, RMV, and other state and national resources to discover needed information that is otherwise difficult to locate.

Medical providers can place claims with us at any stage of the receivables process.  Hence, the Collections team can take your claims either from our Billing team, or aged claims directly from you that have been billed by you or a billing service.  You can also place aged claims that were returned unpaid or closed by collection agencies.  We have a track record of success on obtaining payment for claims that other agencies have worked and given up on.

When the Collections team has exhausted all efforts and payment sources and the claim remains unpaid, they make a careful assessment of the merits of the claim for legal review.  If the claim is qualified, it is forwarded to the legal team for review.
 

Bad Debt Recovery From Insurers

Bad Debt Recovery is an extension of our collection services, and deals exclusively with insurers to obtain payment from them for older claims; we do not contact patients for payment. 
We can take a placement of MVA and/or Workers' Compensation claims that are being considered for write-off or have been recently or long ago written off, where all efforts against the insurers may have been exhausted by you and your collection service providers. 

We will turn this placement into found revenue for your organization by pursuing the insurers for payment using our unique collection techniques and/or legal action (see below for legal services).  We have a track record of success working with claims that everyone else has given up on.  We will take claims up to 6 years old for auto and 20+ years for workers' compensation.

Because our services are contingency based, you have nothing to lose and everything to gain by giving us all of your dead-ended auto accident and workers' compensation claims.
 

Legal Services

Legal review and action against insurers is the final and normally neglected phase in the claims processing continuum.  Our legal services deal exclusively with insurers to obtain payment from them, we do not pursue patients for payment.

We have a direct and integrated relationship with the firm having the best and proven track record in getting claims paid, Upper Falls Law Offices (UFL; formerly known as Fireman and Associates LLP).   They have won countless cases against insurance companies, have won over 40 appellate decisions in MA and NH, and have a 90% litigation success rate.

When a claim is referred to UFL, the merits are evaluated by an expert attorney.  If the claim qualifies, UFL will make various attempts to settle the claim with the insurer, using escalating levels of direct communications.  Due to UFL's expertise and well-known reputation in the industry, they are able to settle most claims quickly.

The more difficult claims and recalcitrant insurers are referred for litigation against the insurer.  UFL will never prepare or file a lawsuit on any claim without prior approval from the medical provider.  Lawsuits often conclude in settlement, and some are brought to trial where UFL prevails in the majority of cases and recovers full payment.

ARMS' systems and data are shared and fully integrated with the law firm, which allows UFL to operate with great efficiency and contributes to their outstanding track record.
 

Consulting

ARMS can help your organization improve their policies, processes, procedures, and systems with respect to auto accident and workers' compensation cases.  We leverage our vast experience and expertise in this specialized area to help your staff improve their intake, billing, and/or collection efforts. 

We offer this service independent of any outsourcing relationship you may have with us.  Our goal is to improve your bottom line, whether it is through partial or total outsourcing, through consulting to help you recover more faster, or both.
 

Revenue Enhancement

RAC appeals
Credit Balance Reviews