Services

We Know Where to Look and What to Look For!

ValuMax™ services help Hospitals recover their full contracted revenue.

  1. The ValuMax™ Managed Care Engine is fine-tuned to the complex transactional and payment environments insurance companies create and control.
  2. Our staff has modeled thousands of payer-contracts during the past 16 years.
  3. Last year we recovered more than $4.3 million for one of our clients, a small hospital system.

We Know Where to Look and What to Look For!

  1. Real-Time Underpayment Recovery
    “We stop the timely appeals clock” by using our ValuMax™ Managed Care Engine to immediately review your paid and denied claims at the end of each month. With this service we effectively ensure that 100% of all eligible challenges to the payers are submitted on time and that our clients recover denied accounts and underpaid cash now, BEFORE GRIEVANCE DEADLINES and not several months in the future.
  2. Zero Balance Underpayment Recovery
    Using our ValuMax™ Managed Care Engine we find recoverable underpayments before timely appeals deadlines expire and your money is lost forever. Because of the complex and burdensome task of reconciling payments with contract terms, your staff cannot check every single item. We ensure identification and pursuit of challengeable underpayments until they are recovered, or resolved consistent with the provisions of your Payer-contracts.
  3. Settlement and Contract Renegotiation Support

    With our ValuMax™ Managed Care Engine we analyze payer-contract terms, billings and payments to identify patterns in underpayments and denials. The results of our analysis are sorted by payer, account, reason code, amount of underpayment, etc. Additional analysis can help identify patterns in contract-payer denials and inefficiencies in customers’ billing methods.
  4. Appeals and Denials

    We provide the full range of appeal processing. We manage administrative denials including claims with no authorization or no referral. We also we have the resources to challenge clinical denials including medical necessity.
  5. Early Out and Backlogged Accounts
    Our ValuMax™ Managed Care Engine calculates maximum reimbursement to ensure that claims have been appropriately submitted. Our professional staff immediately follows-up with payers and monitors claims status to expedite recovery.

Managed Care Financial Strategies, Inc., is a subsidiary of Care Payment Systems, Inc.