Claims Handling & Payment
Analysis Group consults and provides testimony involving claims handling and payment issues. While our expertise spans all aspects of insurance, we have particular experience involving health care billing and reimbursement practices, automotive claims, and home warranty policies.
We have consulted and provided expert testimony on coding and billing practices and reimbursement levels in numerous disputes among health care payers and providers, including hospitals, physicians, and medical equipment suppliers. This experience has given us a deep understanding of both the contracting practices of health plans and providers, and the claims submission and reimbursement process. In claims handling cases involving
health care payers and providers, we routinely work with large electronic data sets of claims and payment records. In many cases, we have also applied appropriate
statistical sampling techniques to obtain accurate data on specific claims handling issues that are not routinely stored in electronic databases but may instead be in paper documents or imaged claims files.
Our projects often include:
- Identifying and evaluating claims handling and payment methodologies
- Calculating claims payment amounts under alternative conditions
- Identifying claims reserving levels and calculating reserves under alternative conditions