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HCR

Healthy Plushas partnered with the GRG Recovery Group to utilize the ERISA (Employment Retirement Income Security Act) which is a set of federal mandates under the U.S. Department of Labor that allows Healthcare Providers to appeal commercial insurance claims from years past.

• Appeals are executed at a federal level, as opposed to state level

• Healthcare Providers are given the same rights under federal jurisdiction as their Patients

• Healthcare Providers earn ERISA protection when they treat Patients who have self-funded employer benefits

• Applies to self-funded and fully-funded employer benefit plans

What is HCR?

The advantages are very simple:
NO UPFRONT COST
NO LITIGATION
NO RISK - the recovery fee is contingent on realized recovery.

What are benefits of HCR?

Every year, Healthcare Providers across the U.S. are writing off millions of dollars in commercial claims. To address this problem, GRG (GRG Recovery Group) has perfected a claims recovery method using U.S. Department of Labor ERISA (Employee Retirement Income Security Act) mandates in an effort to reopen the timely-filing windows on previously closed commercial claims. If a commercial claim is found to be non-compliant with ERISA mandates, identified claims dating back to January 1, 2010 have the ability to be appealed on behalf of the Provider. GRG is dedicated to helping Providers bring dead claims to life, and reward Providers with the reimbursements that they ultimately deserve.

Why is it important to you as a Healthcare provider?

  1. GRG to gather claim data from the Provider:
    – Patient Explanation of Benefits (EOB)
    – Patient Insurance cards/verification form
    – Appeal notes (if necessary)
    – Payer contracts/negotiated rates (if applicable)
    – Provider NPI numbers
    – Provider Tax IDs
    – Copy of the Provider’s claim form
    – Authorization forms for negotiation (if necessary)
  2. GRG to gather access from the Provider:
    – Access to Provider’s payer portals is required for tracking
    – Provider to provide GRG with a point-of-contact (name, email, phone, fax)
  3. Upload claim data into our HIPAA-compliant Secure FTP site
  4. GRG Recovery team to review and analyze claims
    – If necessary, GRG will request additional information from the Provider
  5. GRG Recovery team to contact employer groups to request the Patient’s Summary Plan Description
  6. GRG Recovery team to create Demand Letters to send to Payers via certified mail
  7. GRG Recovery team to follow-up with Payers and claim adjudication statuses
  8. GRG to update Providers once a month with progress (tracked claims)
  9. Once recovery dollars enter the Provider’s Payer Portal, GRG will invoice Providers at the end of each calendar month

Steps to Claims Recovery Process:

Healthy PLUS - AWV

Chronic Care Management (CCM)

Toxicology

Allergy Testing

DNA / Genetics (PGX)

Engagement Center