Six kinds of practice.Six different ways to lose a claim.

The work is the same everywhere: get the claim right, get it paid. Where it goes wrong depends on what you do. Here is what we usually find.

Clinics & medical centres

Multi-doctor general and family practices, walk-in and urgent care centres.

Where claims usually fail

  1. 1High volume, low value claims that nobody has time to re-work
  2. 2Eligibility not checked for walk-in patients
  3. 3Small coding errors repeated across hundreds of claims

Where we start

Denied Claims Recovery 

Specialists

Single and group specialist practices — orthopaedics, cardiology, dermatology, obstetrics and more.

Where claims usually fail

  1. 1Procedures that need prior approval, done before it arrived
  2. 2Higher-value claims stuck in long appeal cycles
  3. 3Modifiers and procedure combinations payers question

Where we start

Eligibility & Pre-authorisation 

Hospitals & day surgery

Private hospitals, day surgery and ambulatory care centres.

Where claims usually fail

  1. 1Complex claims with many service lines and many hands
  2. 2Authorisations that expire or don’t cover the full stay
  3. 3Large aged receivables spread across many payers

Where we start

Full Revenue Cycle Management 

Labs & imaging

Diagnostic laboratories, radiology and imaging centres.

Where claims usually fail

  1. 1Referral details missing or mismatched on the claim
  2. 2Tests and scans not covered by the patient’s plan
  3. 3Thousands of small claims, each too small to chase by hand

Where we start

Receivables Follow-up & Reporting 

Dental

General dental practices, orthodontics and dental groups.

Where claims usually fail

  1. 1Treatment plans approved in part, billed in full
  2. 2Frequency and annual limits reached without anyone noticing
  3. 3Missing documentation — notes, charts, images — on submission

Where we start

Eligibility & Pre-authorisation 

Allied health

Physiotherapy, occupational and speech therapy practices, and other allied health providers.

Where claims usually fail

  1. 1Session limits and referral requirements per payer
  2. 2Course-of-treatment approvals that lapse mid-course
  3. 3Billing done by clinicians between appointments

Where we start

Receivables Follow-up & Reporting 

On fit

Size doesn’t decide fit. Volume of unpaid claims does.

A two-doctor clinic with a year of unworked denials can gain more from recovery than a large group with a healthy billing team. The audit tells you which you are.

Not sure which you are?

Start with a free claims audit