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

Argos Health has helped customers find additional sources of revenue through accounts that customers thought were dead or closed. The firm effectively utilizes their technology and industry knowledge to increase client collections and incoming revenue. They also advise customers on changes they could make to more effectively bring in owed revenue. Clients say Argos Health has been able to find where customers were underpaid for certain procedures or treatments and then go after that revenue to make sure providers are paid what they are owed.

In 2019, Argos Health acquired Caid Solutions. Clients who transitioned from Caid Solutions to Argos Health say that the move was uneventful and that the high level of service they were accustomed to remained consistent throughout the acquisition. Among Argos Health’s general client base, some customers report they had a rough start with the firm, with some system kinks that had to be worked out. However, after some time, these issues were resolved, and their satisfaction improved; today they report high value and high satisfaction from Argos Health’s complex claims services.

Multiple Aspirion clients describe the firm as “part of [the] team”—they feel the firm goes above and beyond their contract both in helping collect owed revenue and in training organization personnel to increase efficiencies and implement practices that will lead to higher collection rates. Respondents using Aspirion have seen increased collections since going live with the firm, a tangible result that makes the cost of the firm well worth it. Communication with clients is strong, as is executive communication when it is needed; however, executive intervention is rarely necessary because of well-trained, knowledgeable frontline employees who ensure few major problems arise. Proactive communication is a high point for many clients, who say Aspirion proactively reaches out to them to share information about changing requirements or best practices to help improve collections.

Bolder Healthcare Solutions generally delivers a positive experience to clients. However, they have the second-lowest overall score in this research, in part because of a single dissatisfied client who moved to Bolder Healthcare as part of an acquisition a few years ago. This organization appears to have been dissatisfied before the acquisition and to have seen little change in their experience; this client feels the firm has not been as aggressive as they would like in going after revenue and collections and has not lived up to expectations around communication. Other clients also mention the high number of acquisitions Bolder Healthcare has gone through, and one mentioned being tired of the constant changes. Other clients express frustration with communication issues (some acquisition related), leading to unresolved problems and low satisfaction with executive involvement.

When it comes to complex claims expertise, clients generally feel that Bolder Healthcare personnel are knowledgeable about the claims they are handling. Clients who know their customer success manager are very satisfied with their experience, and these respondents say this leads to high satisfaction overall with Bolder Healthcare and their services. Clients also report that Bolder Healthcare is great at finding money in accounts that clients thought were dead, and this has led to improved revenue flow.

Insights on EnableComp and their complex claims services are based on a limited sampling of clients. The four respondents in this research report they were able to get up and running with the firm quickly. They describe EnableComp’s reporting as helpful and say communication with account managers is strong. EnableComp is also good at driving tangible outcomes (e.g., increased revenue, efficiency).

Insufficient data to show EnableComp Customer Experience Pillar scores

Kemberton Healthcare Services is the lowest-performing firm in the complex claims space. Clients are highly divided in their satisfaction; about half rate the firm very high, and about half rate the firm low or very low.

Kemberton clients who are satisfied have achieved satisfactory results and feel the firm has the skills and knowledge needed to navigate through complex hurdles and get claims paid. These clients usually point to a working contact or account manager with whom they have built a good relationship over time; these contacts are helpful at solving issues, answering questions, and building confidence in the firm’s abilities.

The gap between satisfied and dissatisfied clients appears to be centered around the firm’s communication. Dissatisfied clients say Kemberton does not communicate effectively and has fallen short on responding to and resolving issues, making it difficult to form a successful partnership. Overall, larger customers are less satisfied than their smaller peers; clients with over 250 beds rate the firm about 12 points lower (out of 100) than organizations with less than 250 beds, and higher bed size is correlated with lower ratings.

A standout percentage of interviewed Revecore clients say the firm’s services have substantially increased the organization’s cash flow/revenue. Revecore is the only firm in this report to have 100% of respondents say the firm exceeds their expectations. This creates strong relationships with clients, who often describe the firm as a partner. Revecore sends personnel on-site to train client organizations and help them learn how best to handle complex claims to ensure they are paid. Customer success managers assigned to client accounts are also well trained, knowledgeable, proactive, and personable. Several respondents describe Revecore as the expert in their field. Overall, Revecore clients are highly satisfied with their experience and likely to recommend Revecore to peers.