Complex Claims Services 2024
In the Wake of Mergers & Acquisitions, How Well Are Firms Delivering Value?

Recent Mergers & Acquisitions

• At the end of 2021, EnableComp completed their merger with Argos Health
• In 2022, Revecore acquired Kemberton
• In 2023, Aspirion acquired Continuum Health Solutions and FIRM Revenue Cycle Management Services

Revecore’s Reliable Processes & Expertise Lead to High Client Satisfaction

Revecore is the 2024 Best in KLAS winner for complex claims services, and in general, respondents have been highly satisfied with the firm’s performance over the past few years (both before and after the acquisition of Kemberton). Most respondents primarily use Revecore to process MVA or workers’ compensation claims. 95% say Revecore exceeds expectations thanks to (1) useful expertise, (2) smooth deployments and execution, and (3) strong relationships. The firm’s expertise exceeds that of customers’ internal teams, especially regarding legal recommendations. Respondents also highlight the ease of sending claims to Revecore and the consistency of the claims process, as the firm rarely misses any steps. Regarding strong relationships, the firm is described as a partner, with respondents citing regular engagement and open lines of communication with representatives at all levels. Further, Revecore adapts to the needs of respondent organizations and is willing to provide ad hoc reporting, adjust processes, and offer assistance that goes beyond regular project scope.

Amid Growth, Aspirion Deepens Partnership via Communication & Ownership; Some Clients Would Like to See Better Value

Aspirion respondents primarily use the firm for MVA and workers’ compensation claims and are generally satisfied. Most say the firm’s resources are very knowledgeable and understand how to handle complex claims, as they are persistent and handle negotiations effectively. Aspirion is also described as taking real ownership of accounts and acting as an extension of client organizations, treating each client’s A/R as it if were their own. Respondents say the partnership has improved, pointing to Aspirion’s consistent, transparent communication that helps ensure satisfactory performance.

In addition to recent acquisition activity, Aspirion had leadership changes in early 2023. A couple of respondents note the new leadership has brought more expertise to the firm. However, clients have seen some negative impact from the firm’s fast growth. A couple of organizations say staff turnover has caused performance gaps, and one client has had to train or re-train resources on the organization’s workflows. A couple of respondents question the value of Aspirion’s work, saying they occasionally have to do some manual work on behalf of the firm. These clients would like Aspirion to better manage inventory and dedicate more time and attention to low-dollar claims.

EnableComp Stands Out for Workers’ Compensation Claims Thanks to Extensive Industry Knowledge; Client Satisfaction Varies for Other Claim Types

EnableComp is generally seen as a strategic, flexible partner that collaborates with clients to meet their unique needs. The majority of respondents use the firm for workers’ compensation claims, and almost all are highly satisfied with these services thanks to the firm’s extensive expertise. Additionally, EnableComp is the only firm in this report with more than 50% of their interviewed customers using VA claims services. Generally, respondents say EnableComp offers guidance and shares meaningful trends that help improve organizational processes. Many customers also note that the firm is quick to respond to questions or issues and that the direct contacts allow for open lines of communication.

For respondents who use EnableComp for claim types other than workers’ compensation, client satisfaction is low due to a lack of expertise and slow processes. They also say EnableComp doesn’t proactively partner with them to lead out on collection strategies. Some of these organizations are evaluating their long-term plans with EnableComp and looking elsewhere for services. For those who were previously Argos Health clients (before merging with EnableComp), feedback is mixed. A few say the quality of their experience has been maintained or even improved; others would like the firm to be more proactive and eliminate manual tasks that clients are currently responsible for.

Across the Market, Satisfaction with Reporting Is Driven by Transparency into Performance & Flexibility with Ad Hoc Requests

Healthcare organizations rely on their firm’s reporting to understand how well the firm drives outcomes. Client satisfaction with the reporting often depends on transparency into the firm’s engagement, the level of detail provided, and the firm’s ability to accommodate requests to break out the data. Across the three measured firms, client satisfaction with reporting varies (see the accompanying chart).

Other Firms That Offer Complex Claims Services

KLAS is aware of other firms that offer complex claims services. KLAS interviewed one organization that uses Centauri Health Solutions for out-of-state Medicaid claims and one organization that uses Cognizant for MVA claims. Also, Firstsource and R1 RCM are validated as being used for out-of-state Medicaid claims and workers’ compensation claims, respectively. (Of note, R1 RCM acquired Cloudmed’s complex claims solution in 2022.) Some respondents use Accelerated Claims (ACI) for MVA and workers’ compensation claims, and a few are interested in Knowtion Health’s offering; neither of these firms is currently measured by KLAS.

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 12 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 client experience pillars—loyalty, operations, relationship, services, and value.

To supplement the performance data collected, KLAS also asked interviewed clients the following questions specific to complex claims services:

1. What types of claims does your firm process for you?
2. Do you use an additional firm for complex claims? If so, what firm(s), and what types of claims do they process for you?
3. Do you anticipate expanding, maintaining, or reducing your scope of work with your firm in the future?
4. Rate your satisfaction with how well your firm’s reporting meets your needs.
5. How satisfied are you with your firm’s performance when they process applicable claim types (i.e., MVA, VA, workers’ compensation, out-of-state Medicaid, TRICARE)?

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 following table 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 solution can change from question to question. When the number of unique organization responses for a particular question is less than 10, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 5, no score is shown. Where textual content relies on limited data, the firm name is marked with an asterisk. 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.