What the review looks for
The review looks for recurring payer reductions, underpaid out-of-network claims, missed IDR opportunities, denied reimbursement, aging balances, and documentation gaps that may affect recovery.
Audit vs legal claim filing
A revenue recovery audit identifies possible opportunities and organizes facts. Filing a claim, arbitration, or lawsuit is a separate decision based on eligibility, deadlines, documents, economics, and legal strategy.
Who should request one
Physician groups, ASCs, hospitals, imaging centers, PT and chiropractic practices, billing companies, and healthcare operators may request review when payer disputes are creating meaningful A/R pressure.
Frequently asked questions
Can a provider challenge an underpaid out-of-network claim?
Yes. A provider may be able to challenge an underpaid out-of-network claim if the claim is eligible, documented, timely, and economically viable. The dispute route depends on the payer, plan, service, and applicable law.
What documents are usually needed?
Useful documents may include EOBs, claim data, payer correspondence, plan or contract terms, denial letters, open negotiation records, and payment histories. The exact documents depend on the dispute type.
How long does arbitration take?
Timing depends on the dispute forum, payer objections, claim volume, documentation, and statutory deadlines. No single timeline applies to every reimbursement dispute.
Is recovery guaranteed?
No. Recovery depends on the facts, documents, law, payer conduct, deadlines, and dispute strategy. A review can identify potential paths, but it cannot guarantee an outcome.
Does Halkovich Law work nationwide?
Yes. Halkovich Law represents healthcare providers and facilities across the United States in provider-side reimbursement disputes, No Surprises Act arbitration, and related litigation matters.