Protecting the accuracy of your medical bills


Who We Audit:
Blue Cross Blue Shield (BCBS)
And many others!
How we get your
maximum refund:
  • Verify that the service provided was covered.
  • Verify that the patient was eligible.
  • Determine if another entity was responsible for payment
  • Determine if the billed services were for the patient.
  • Regarding procedure based payments, verify that the procedure was appropriate to services performed.
  • Determine that the appropriate PPO discount was taken and contract terms were adhered to.
*For Claims over $5,000, going back 2 years.

Medical Recovery Group represents corporations that self-insure their health care benefits. We review claims that have been paid by the corporation's Third Party Administrator (TPA) for errors and overcharges. We then negotiate refunds on our client's behalf.

Why Audit?

Significant errors are made in healthcare claims processing everyday. Duplicate charges and other billing mistakes from hospitals and other providers often go undetected. Discounts available through your PPO Network are often missed or miscalaculated, resulting in large overpayments. Some claims are even paid twice. Coordination of Benefits (COB) and other third-party liability opportunites such as subrogation are missed.

In an increasingly complex healthcare payment environment, these facts are a formula for over-payments - costs that impact your bottom line.

What We Do:

We have several types of audit services available. The information below details our focused audit, a service provided to clients with 500-175,000+ empoyees for claims exceeding $1,000. For information about our other audit services, contact us.

  • Preliminary review of all claims paid at $1,000 or more retroactive for the past 2 years.
  • Limited scope review to look for duplicate payments and missed discounts for claims in the $1,000 to $5,000 range.
  • In depth review for claims over $5,000. See right.
  • Review claims history to ensure claims were not paid more than once.
  • Coordinate refunds from the appropriate healthcare providers.
  • Confirm our clients receive their refund.