Revenue doesn't disappear — it hides. We investigate the medical claim from both sides: physician practices losing money to denials and underpayments, and Medicare & Medicaid health plans exposed by payment accuracy and timeliness gaps. Claim by claim, evidence over assumption.
We investigate. You collect.
Buried in a denial code. A misconfigured rate. A claim nobody followed back up on. Most of it is never found — because nobody went looking at the claim level.
Ranges reflect benchmarks commonly cited in revenue cycle and claims-operations research. Your case file quantifies your own numbers — not an industry average.
Two phases. No dashboards standing in for evidence — the claim file itself does the talking.
We start with your claims data, not a survey. We benchmark denial rates, payment timing, A/R aging, and collection patterns against industry norms and identify exactly where your numbers break from what they should be. Discovery ends with a sized opportunity worth investigating further.
This is where the casework happens. We go claim by claim into the files behind the patterns Discovery flagged, tracing each one to its root cause — a denial code, a misconfigured rate, a claim that fell out of a queue. Investigation ends with quantified findings and a remediation plan your team can execute.
The trail runs in both directions — so we investigate from both sides of the transaction.
Anonymized, generalized summaries. Every engagement's specifics stay with the client.
The health plan's internal dashboards showed payment accuracy within acceptable range across every reported category. The Investigation phase pulled a claim-level sample from a single high-volume claim type and found a fee-schedule configuration error that had gone live fourteen months earlier. No automated edit caught it, because the edit was built to check the wrong field. The finding was quantified, traced to the exact configuration change, and handed back with a corrected remediation path — plus a re-measurement plan to confirm no other claim types carried the same defect.
The practice had normalized a steady monthly write-off as the cost of doing business — "that's just how billing goes." Discovery flagged an aging pattern well outside benchmark. Investigation traced it to one clearinghouse rejection code that front-desk staff had been manually clearing without resolving the underlying eligibility mismatch it flagged. Every claim behind that code was still inside the timely filing window. The practice recovered the majority of the balance and closed the front-end gap that created it.
A routine compliance review flagged a rising rate of appeal determinations issued outside the state-mandated window. Investigation traced the delay not to the appeals team itself, but to an intake step three departments upstream, where correspondence sat in a shared queue with no clear owner. Once the bottleneck was named and reassigned, the compliance gap closed — and the plan had documentation showing exactly why, ready for its next regulatory review.
We hand you the file — the evidence behind every number, not a summary of it.
Every engagement runs on the same five principles, regardless of size.
We don't estimate what we can verify. Every finding traces back to a specific claim.
A denial code is a symptom. We keep asking why until we reach the actual cause.
Our findings are documented in the claim data itself — not in our opinion of it.
A $4,000 recovery gets the same rigor as a $400,000 one.
Our recommendations follow the evidence, even when it's inconvenient — for you or for us.
Tell us whether you're a physician practice or a health plan, and where you think the leakage is. We'll follow up to scope a Discovery engagement.