What is a Revenue Recovery Review?
A Revenue Recovery Review is an initial attorney-facing review request for healthcare providers with underpaid, denied, or disputed insurance claims. It collects basic information about organization type, market, claim volume, payer issues, and A/R pressure so Halkovich Law can evaluate whether reimbursement disputes may warrant legal review.
What claims can be included in the review?
Claims may include No Surprises Act IDR matters, commercial underpayments, out-of-network reimbursement disputes, ERISA or self-funded plan issues, NJ PIP claims, and NJ Workers' Comp reimbursement disputes. Eligibility depends on the facts, documents, payer, deadlines, and dispute procedure.
What is the difference between an underpayment and a denial?
An underpayment occurs when a payer pays less than the provider believes is legally or contractually owed. A denial occurs when the payer refuses payment in whole or in part. Both can create recovery opportunities, but the documents, deadlines, and dispute route may differ.
When should a provider request a review?
A provider should request a review when disputed balances are significant, payer patterns repeat, internal escalation has stalled, or statutory deadlines may apply. Early review helps identify whether claims should move toward negotiation, IDR arbitration, litigation, or another reimbursement recovery path.