Complex Claims Services 2020
Bringing Knowledge and Skills to the Claims Market

Author
Boyd Stewart

Author
Alex McIntosh

May 19, 2020 | Read Time: 14 minutes

Some healthcare claims are harder to manage than others—in particular, out-of-state Medicaid, motor vehicle accident, VA, and workers’ compensation claims. In order to focus their resources on other claims, provider organizations often contract on a contingency basis with specialized firms who have ample experience handling one or more of these complex claim types. Typically, these firms achieve higher paid-claim rates and cash recovery than organizations would on their own. This report is meant to help provider organizations find the right firm for them by examining which firms manage which types of claims and how well each firm performs for clients.

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Key Findings

Types of Complex Claims Covered in This Report
What Firms Do Is Just as Important as How Well They Do It—Few Apples-to-Apples Comparisons
Wide Variation in Overall Customer Experience: Revecore Leads Generally High-Performing Market; Kemberton Lags Behind
Revecore, Aspirion, and Argos Health Partner with Clients beyond Simply Working Complex Claims
Argos Health
Aspirion
Bolder Healthcare Solutions
EnableComp
Kemberton Healthcare Services
Revecore

Writer
Amanda Wind Smith

Designer
Jess Wallace-Simpson

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2021 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.