Our Programs

HCSG is a technology company that specializes in business process reengineering for healthcare organizations. We aren't just a paid claim recovery company, nor are we just a billing company. We develop innovative technology that makes all of those things work better. Better outcomes, in less time, with fewer resources.

That's HCSG.

Subrogation case identification (even when members don't respond)

When a health plan suspects a claim was the result of an injury, they use questionnaires as the primary tool for gathering information from members. These questionnaires are usually effective. But when members do not respond to questionnaires, or provide information that isn't as accurate as it could be, payers don't have a lot of options. After all, you can't pursue a recovery if you don't have all the facts.

HCSG offers an innovative identification program that finds the facts—even when members are not being cooperative. The program does four fundamental things:

  1. It evaluates and enhances the claims data you send to us to avoid the impact of bad addresses, name changes, etc.
  2. It uses an innovative claims matching application against multiple third-party databases to identify injuries where another payer is liable.
  3. It scrubs the data that is returned to eliminate false or faulty returns, and screens out information that is not relevant.
  4. It prepares cases that your subrogation staff can begin pursuing immediately.

Call us today to learn how our program can help you identify more subrogation recovery opportunities, even when other methods won't.

Automated overpayment identification

Across the industry, healthcare payers are generally very effective at paying claims accurately. Still, the sheer volume of claims that are processed, combined with other complexities beyond your control, mean a small portion of overall claims are overpaid. Even though the portion is small, in the aggregate, these claims can still result in a significant amount of recoverable revenue.

This is where we can help.

HCSG offers a fully automated overpayment identification system that quickly and efficiently identifies overpayments, including improper coding, up-coding, double billing, and coverage issues. Our automated identification platform, combined with proven recovery strategies, leads to shorter recovery cycle times, reduced expenses, and a significant increase in your net recoveries.

Call us today to learn how our automated overpayment recovery program can help you identify and recover the money you are owed.

Workers' compensation recoveries in New York State

Every workers' compensation program is unique to each state, with unique rules and procedures for recovering payments. This is precisely why your workers' compensation recovery program should be built specifically for the state where you operate. The correct program, appropriately configured, will typically recover significant revenues on your behalf. However, a "generic" program — one that's not built specifically for your state — will leave tens of thousands or even millions of dollars unrecovered.

HCSG offers the most mature and effective workers' compensation recovery program for New York State. It completely automates the identification, verification, and recovery process. It is so automated, in fact, that it can identify and verify recoverable claims, and submit the required recovery paperwork—all within about five days from receiving your claims. Moreover, we can typically process your recoveries and submit them back to you within about 60 days. That means more recoveries, faster.

If you are a health plan operating in New York, call us today to learn how our turn key program can help you identify and recover significantly more workers' compensation recoveries in less time than you're doing today.

Custom programming solutions

Sometimes, the tool you need doesn't exist, and your IT department is just too swamped to get it developed. HCSG has a tool box filled with unique and innovative applications that we developed to meet the specific needs of our clients.

These are only a few of the many custom applications we have developed for our clients, and that are available to you.

If you need a custom application for your business, call us today. We are always happy to discuss special projects.

Highlights

After a competitive review, a major insurance company chose HCSG because we identified a larger number of subrogation recovery opportunities far more accurately and quickly than any other vendor.

HCSG is able to identify and verify recoverable subrogation opportunities before most existing subrogation programs are able to mail a questionnaire.

HCSG's workers' compensation program is so automated it can identify and verify a work-related injury, and prepare a demand package—all within a single week.

HCSG's workers' compensation program is so effective that we win over 98% of all cases that go to arbitration.

One of our New York workers' compensation clients switched to another vendor that was offering a lower fee. The other vendor was using a recovery program that wasn't designed for New York. The other vendor's recoveries were so low that the client re-hired us within the same year.