Complex Claims Services 2022
Who Delivers Consistent Results?

Argos Health, an EnableComp Company, Engaged across Claim Types

Argos Health, an EnableComp Company (the two companies consolidated in December 2021 but are measured separately in this report), is the firm with the most validated clients for out-of-state Medicaid claims. They are also validated by several respondents for all three other claim types. Most organizations use the firm for a single claim type rather than multiple types. Organizations using Argos for out-of-state Medicaid claims are less satisfied compared to the rest of the client base, but it is worth noting this claim type generates lower satisfaction market-wide (on a 1–9 scale, the average overall satisfaction rating is 8.0). Across firms, organizations describe these claims as more complicated (e.g., there are many state-specific requirements) and difficult to achieve outcomes for. With the exception of Kemberton Healthcare Services, firms tend to receive slightly higher ratings from organizations who use them for multiple claim types compared to those engaging their firm for a single type.

Revecore Exceeds Expectations with Creative Approaches to Strategic Success 

Inconsistency from Kemberton Affects Overall Client Satisfaction; Revecore & Aspirion Execute Most Consistently

A firm’s consistency of engagement execution is highly correlated with clients’ overall experience. Interviewed Kemberton Healthcare Services clients are divided on the firm’s performance in this area. Among this report sample, respondents are about equally likely to have a good experience or a poor one. The clients who rate the firm lowest for engagement execution report that Kemberton Healthcare Services has missed deadlines and not collected on claims expected by the organization. Another identified issue is knowledge gaps, which may be caused by reported staff turnover. These problems generally erode respondents’ trust and contribute to a weaker sense of partnership between clients and the firm.

Consistency of execution is also a problem for Argos Health and EnableComp, though to a slightly lesser extent. Almost half of Argos Health respondents report some dissatisfaction with the engagement execution—these clients frequently mention their main issue was not achieving expected outcomes. A couple of interviewed EnableComp clients rate the firm particularly low for engagement execution, citing situations where they felt they had to monitor the firm’s resources to make sure claims were handled correctly. This is most often an issue with VA claims. Clients of Revecore and Aspirion rarely mention gaps in engagement execution, and when they do, these tend to be minor inconveniences that are addressed quickly.

High-Touch Relationships from Aspirion & Revecore; EnableComp & Kemberton Less Consistent, with Kemberton Making Improvements 

Client success depends heavily on having someone at the firm empowered to solve problems—this is measured by KLAS as executive involvement. Clients of Aspirion (limited data) rate the firm high for executive involvement, citing strong communication, timely responses and resolution, and good problem-solving from the firm. Revecore clients often mention positive experiences with communication and responsiveness. Argos Health clients also feel their contacts at the firm are responsive and timely, but they don’t often mention receiving proactive communication. Executive involvement is inconsistent for EnableComp clients; several mention that even though they have a project manager who communicates well, the organization still has to stay on top of EnableComp’s resources and frequently check in to ensure their work is executed properly. These clients would like the firm to take some of that burden off their shoulders.

Kemberton Healthcare Services (limited data) has improved in their executive involvement overall—their rating for this metric has risen a full point (on a 1–9 scale) in the last year. As a result of recent staffing and leadership changes at the firm, particularly around account management, several clients say they are seeing better executive involvement, which has led them to believe Kemberton will continue to improve. A few others report they have not seen improvement as a result of these changes.

“One of the reasons we had issues is that there has been a transition in staffing. The situation seems to be improving. . . . Their claims resolution has improved over the last couple of months, and we hope to see that improvement continue. The drive is there for a good partnership. . . . Kemberton Healthcare Services does well in terms of having someone higher up who frequently meets and works with us. The firm has great intentions; they really want to work with us and be successful.” —Business office director (interviewed October 2021)

EnableComp & Aspirion Most Often Increase Revenue; Argos Most Often Decreases A/R Days 

KLAS asked respondent organizations which key outcomes they see from adopting their firm’s services. 86% of interviewed EnableComp and Aspirion clients cite increased revenue. Argos Health had the highest percentage of respondents (83%) pointing to decreases in A/R days as a result of using the firm. Improved patient experience is less frequently reported across firms’ client respondents; the small number who cite this outcome say they have been able to reduce calls to patients and lighten the burden on patients, since the firm can work directly with patients’ insurance companies. Other mentioned outcomes include timely returns and less strain on the organization staff.

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. For this report, interviews were conducted over the last 18 months using KLAS’ standard quantitative evaluation for healthcare services, which is composed of 9 numeric ratings questions and 3 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into five customer experience pillars—loyalty, operations, relationship, services, and value.

To supplement the client satisfaction data gathered with the standard evaluation, KLAS also created supplemental questions to delve deeper into several areas specific to complex claims services. These questions asked respondents what outcomes they have seen as a result of engaging their firm (increased revenue, decreased A/R days, improved patient experience, or other outcomes).

Sample Sizes

Unless otherwise noted, sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique client organizations interviewed for a given firm or service. However, it should be noted that to allow for the representation of differing perspectives within any one client organization, samples may include surveys from different individuals at the same organization. The table below shows the total number of unique organizations interviewed for each firm or service as well as the total number of individual respondents.

Some respondents choose not to answer particular questions, meaning the sample size for any given firm or service can change from question to question. When the number of unique organization responses for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a firm has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.