P2A’s unique system for monetizing your old data uses our one-of-a-kind Business Intelligence software.

Our BI engine was designed using extensive knowledge gained from three decades of experience building actuarial systems, payer systems, and provider networks. It’s uniquely able to sync payor, provider and contract data spanning going back nearly 30 years and can handle more than 100 million claims. What does that mean for your hospital system?

We take 5+ years of your past data and actually re-bill every claim exactly as their payer contracts prescribe. As a result, we’re able to capture and identify every problem, or mis-pay, from the payors.

How our state-of-the-art recovery system works:

  • We import your old data going back 5+ years into our unmatched Business Intelligence software.
  • P2A thoroughly audits your old claims and bills, and search for issues with each payment. The process is a 100% readjudication of every single claim that the client had, which can be millions of claims for certain hospital systems.
  • Our BI engine readjudicates every claim, automatically recalculating each bill exactly as the hospital's contract states it should have been paid.
  • When an issue with a payment is recognized, we log specifics about that bill, such as what type of bill it was, who the payor was, and other necessary details. Each identified mis-pay is assigned a specific issue code.
  • We also access the benefit code for each past claim. A benefit code is a standard code in a payor's system that links a variety of data points (i.e. CPT codes, procedures, etc.) and assigns "like" groupings into specific groups. They’re automatically adjudicated and paid, without any human oversight. We examine a readjudication from the actual contract and then compared to what was actually paid. If there is a difference, we uncover the reason for it.
  • Our Business Intelligence engine effectively links the issue codes to the benefit codes of the payor, and then identifies claims paid incorrectly.

Our comprehensive Contract Value Analysis (CVA) reports are your key to successful recoveries

After our thorough audit of your old data is completed, we provide you with a detailed Contract Value Analysis (CVA) report. It includes a comprehensive analysis of each and every contract that that payor had with your hospital or physician group.

Your CVA reports typically identifies three different types of claim recoveries:

The net cash collection on the 1st CVA is usually equal to 1.5% – 2.0% of the annualized audited claims amount, which is typically equivalent to a full year of operating margins at a hospital…. without seeing a single patient!

  • Normal Miss-Pays or Short-Pays: These are claims that were found to be erroneously writtenoff “zero-balance claims,” which are re-submitted to the payor for recovery and payment.
  • Projects: When we find a large systemic issue (often times in the millions of dollars), hospitals will often prefer to batch these claims together as one project, which leads to a settlement negotiation with the payor.
  • Over-Collections: If hospital expected $1,000 and P2A calculates they should be paid $1,500, they will seek to recover the additional $500. When the same mistake has been made on hundred of bills, the funds owed can multiply into the hundreds of thousands over time!

Our irrefutable data convinces payors to quickly settle your old claims.

Once an issue is discovered, the payor is immediately notified. In most cases, they’ll initially challenge the recovery request. We’ll provide the payor with the 100% audit of every claim they had with you, which quickly leads them to realize we have more control over the data than they do. They quickly move to negotiate a settlement, despite any filing limits or other restrictions.

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Budget-friendly plans

We’re cognizant of the fact that many hospitals are working with limited budgets. We offer flexible programs to make working with us both affordable and profitable. Whether your hospital is operating with no budget or a limited one, you can select from different gain share programs to reduce and even eliminate upfront fees.