Your Ally in Combating Unfair Claims Practices


Helping Independent Practices Remain Independent




Provider Advocacy &
Claims Resolution Services



Recover What's Yours. Protect What You've Earned.​




Overturn Improper Claim Reductions & Denials

Stop Recoupment Offsets Before They Happen

Use The Power of ERISA To Increase Revenue

Increase Contracted Network Rates

Tailored Revenue Defense Solutions

No Interruption to Your Current Billing Process


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Our Services



Solutions That Protect Your Revenue





Denied/Underpaid
Claims Recovery



Insurance payers routinely deny or underpay valid claims, hoping you'll accept their denials and reduced reimbursements as inevitable losses.


We aggressively challenge these improper denials and underpayments by leveraging powerful regulations like ERISA, overturning unfair payer tactics, and securing proper and full reimbursements. All of our claims recovery services operate entirely on contingency - if we don't recover, you don't pay.



Medicare/Government Program Appeals



Medicare doesn't just hand out checks - every dollar comes wrapped in regulations, deadlines, and cryptic denial codes. When Medicare or related programs (Medicaid, TRICARE, VA, or state agencies) reject or underpay your claims, we go to work.


We navigate the maze of CMS regulations and agency guidelines, craft precise regulatory-based appeals, and ensure critical deadlines never slip by unnoticed. Hand us your improperly denied and underpaid claims, and we'll turn them into recovered revenue for your practice.



Worker's Compensation Claims Support



When red tape gets in the way of rightful compensation, we clear the path. WC claims often come with a maze of procedural hurdles, strict deadlines, and rigid payer scrutiny, making fair reimbursement a challenge. Payers and TPAs frequently delay, reduce, or deny payments through technicalities and documentation demands.


We step in to ensure your practice is not unfairly penalized. We review disputed claims, respond to documentation requests, and appeal improper denials and underpayments using regulatory knowledge and proven dispute strategies. Whether you're facing downcoding, denied authorizations, or unclear fee schedules, we help you navigate the process and recover what's rightfully yours, without burdening your staff.




Recoupment Defense



Payers frequently demand unwarranted refunds from providers, particularly targeting out-of-network practices, hoping you'll repay money you've rightfully earned.


We swiftly intervene, using regulatory defenses and targeted appeal strategies to halt these unjustified refund demands. Our deep understanding of insurance regulations helps protect your practice's revenue from payer abuse.




Payer Audit Support



Insurance audits often come disguised as routine checks, but they're frequently used to claw back payments through unjustified denials and refund demands.


We respond quickly and strategically. We begin with a detailed analysis of the audit to determine the scope and intent. We identify any documentation gaps or vulnerabilities and craft a customized, defensible response that directly addresses the payer's findings, citing all relevant payer policies, coding guidelines, and federal/state regulations.


Beyond the initial response, we manage the entire follow-up process, guiding you step-by-step on what to submit and how to respond. This ensures you stay protected, avoid costly errors, and prevent payers from misusing the audit process to withhold or recoup funds unfairly.





PPO Revenue Leakage Prevention & Recovery



Silent PPOs and unauthorized discounts quietly siphon revenue from providers, often without their knowledge or consent.


We perform a meticulous review of your network contracts, identifying hidden discounts and unfair payment reductions. By pinpointing unauthorized network access, we halt revenue leakage and help reclaim lost funds.



Network Contract Negotiations



Many payer contracts, whether initial or longstanding, contain undervalued terms and outdated reimbursement rates, significantly limiting your practice's revenue potential and growth opportunities.


When joining a payer network or renegotiating existing contracts, don't leave your reimbursement rates to chance. Our affiliated specialists apply proven negotiation tactics, deep industry insights, and data-driven analysis to secure optimum rates and favorable terms. We partner with experienced professionals who expertly evaluate your contracts, uncover areas for improvement, and strategically negotiate enhanced reimbursements, ensuring your practice receives the compensation and contract value it deserves.




Contract Check-up



Contracts can contain hidden clauses, outdated fee schedules, and obscure language that subtly reduces your rightful reimbursements.


We thoroughly evaluate your existing managed care agreements, uncovering hidden revenue leaks and identifying contractual vulnerabilities. Our transparent, jargon-free recommendations ensure you maximize every dollar owed to your practice.



Other Services and Strategic Support



Payers count on confusion and complexity to prevent providers from effectively defending themselves against their abusive and unjust tactics.


We provide strategic consultation, document preparation, and payer communications support that cuts through payer confusion. Our specialized support helps your practice proactively handle complex payer scenarios, reinforcing your revenue integrity.






Patient Advocacy


As more out-of-network providers step back from direct insurance billing due to time-consuming payer issues, many now give patients detailed receipts or superbills and leave it to them to file insurance claims on their own.


We bridge that gap. We offer professional claim-filing and appeal services directly to your patients at a discounted rate and no cost to your practice.


Your patients get the freedom of choosing their preferred out-of-network provider without insurance headaches, while your practice gains a competitive edge by offering seamless access to care, boosting patient loyalty, and eliminating billing hassles.



"Major insurance payers often employ unfair tactics to unjustly reduce or deny medical claims, prioritizing profits over fair claims practices. This leaves many independent practices struggling to secure the fair compensation they rightly deserve for their services. As a Healthcare Provider Advocate and Claims Resolution Specialist, over the years I've successfully helped independent practices recover and protect substantial revenue through regulatory-based appeals and strategic dispute strategies, and I can do the same for your practice."



- Kevin Barrett, Provider Advocate and Claims Resolution Specialist,
Operating as MedClaim Alliance





While billing professionals play a vital role in revenue cycle management, billing training programs don't cover the in-depth knowledge of ERISA and other key state and federal regulations needed to effectively challenge improper payer methods that lead to wrongful denials and underpayments. Here at MCA, we're not just appeals support - we're the regulatory firepower your practice doesn't have. Leveraging legal strategy, we help independent practices protect their reimbursements by challenging and overturning payers' unfair claim reduction/denial tactics such as the following:


* Post-Payment Recoupments

* Medical Necessity Denials

* Multiple Procedure Payment Reductions (MPPR)

* Usual Customary & Reasonable (UCR) Underpayments

* Exceeds Maximum Allowed Amount Underpayments

* Silent PPO/Unauthorized Discounts

* Improper Bundling of Charges

* Improper Down-Coding

* Unauthorized Reduction in Payments

* Prior Authorization Denials

* Experimental Denials

*Excluded/Non-Covered Service Denials

* And More...





A Mission Rooted in Advocacy and Results


As a true advocate for independent healthcare providers, we go beyond what might be expected from your billing support. Whether your practice manages billing in-house or you outsource it, we bring specialized knowledge and regulatory expertise that surpasses what most billing professionals are trained to handle. Our work is focused on challenging improper denials, underpayments, and refund demands using powerful tools like ERISA and other federal and state protections. In addition to commercial insurance claims, we now offer support for Medicare and other government program appeals--helping providers like you navigate the unique challenges of these plans and secure the reimbursements you're rightfully owed. This isn't just a service--it's a mission to protect the financial health of independent providers from unfair claims practices by third-party payers.


Why I Advocate For Healthcare Providers:

The Story Behind the Mission


"I didn't set out to be a healthcare provider advocate as I now do through MedClaim Alliance. But looking back, I know I was called to do it.


In 1999, I landed a job at a claims repricing firm. I was new to the insurance industry but was eager to learn. However, the deeper I dug, the more I realized something was terribly wrong. The firm I worked for was engaged in what's commonly known in the industry as silent PPO fraud--a practice where healthcare providers' private, in-network contracted rates are accessed without their knowledge or consent and used to fraudulently reprice their out-of-network claims. That's why it's called a 'silent' PPO--there's no mention of the PPO network on the patient's insurance card. The provider only discovers the PPO repricing after receiving payment. In short, providers are being cheated--and I watched it happen every day.


I witnessed doctors and professionals devastated by the unexpected claim reductions. I heard their voices break in frustration and anger over the phone. They were being taken advantage of, and our firm had an entire department dedicated to defending those unjust discounts. It didn't matter if the repricings were fraudulent--the firm's policy was never to reverse them.


After three years, I couldn't take working there anymore. The corruption, fraud, and deception at the core of the company's business model seeped into every level of its operation--including how management treated staff and ran the company. It wasn't just an unethical business--it was a toxic environment. So I walked away from the best-paying job I ever had, knowing that I had to do something different--something honest.


Looking back, I now realize I wasn't just walking away from corruption--I was being equipped. The experience gave me rare inside knowledge, once used to shield insurers, that I now believe I've been called to use in defense of healthcare providers. I believe I was placed in that environment for a reason--so I could later fight for the very professionals I once saw being taken advantage of.


With that mission in mind, I launched my own business to offer a transparent alternative to the claims repricing industry: negotiated out-of-network claim settlements, where providers had a voice and knew exactly what to expect. No hidden deductions. No silent PPO repricing. Just fair, upfront agreements. And for a while, it worked. But honesty doesn't always win in a system that rewards deeper discounts. Because payers prioritized the deeper discounts available through claim repricing over fair negotiated agreements, I was unable to grow my business. Eventually, I lost my last client--and with it, the business itself.


As a man of faith, I turned to God in prayer--seeking His guidance for what to do next. In answer to my prayer, He gave me a vision: I saw a doctor clenching insurance claims in both hands, shaking them in frustration because he couldn't get the insurance payers to pay what they're supposed to. At that moment, I felt his frustration--and I knew what God was calling me to do.


I believe that my time inside the claims repricing industry--though difficult--was not wasted. It gave me rare, firsthand insight into the deeply rooted corruption and deceptive practices many insurance payers use behind the scenes to unjustly reduce and deny medical claims.


Armed with that experience, I've made it my mission to help healthcare providers fight back and win. It's been a long and challenging journey, as I've come to see just how aggressively payers will defend their unfair claims practices--and how far they'll go to protect the profits tied to systemic abuse. To combat this, I immersed myself in ERISA and other key state and federal regulations with extensive and ongoing research, study, and training from industry experts--learning not just how to push back, but how to advocate, how to fight, and how to win. This is my passion and mission, not just a service.


I know the battle you're facing: relentless underpayments, unjust denials, and a payer system designed to wear you down. I've seen the system from the inside, and now I'm using everything I've learned to fight for those who deserve better: independent healthcare providers like you, who are doing good in this world and getting shortchanged for it. You shouldn't have to combat payers just to get paid for your work. That's what we're here for."

- Kevin Barrett, Owner-Operator


The Fight to Protect Independent Practices


Independent practices are the backbone of our healthcare system. You offer personalized, hands-on care, build trust with patients, and fill critical gaps that large healthcare systems can't. But while you're focused on patient outcomes, insurance payers are focused on minimizing payouts--and they have entire departments dedicated to doing just that.


This is where the imbalance begins. Unfair claim denials, underpayments, delayed reimbursements, silent PPO discounts, recoupment threats--these aren't random flukes. They're systemic strategies designed to delay, deny, and reduce what you're rightfully owed. And the truth is: you're not just treating patients, you're in a battle with payers who know the rules better than you do. That's why having an experienced advocate on your side isn't just helpful--it's essential.


As a dedicated healthcare provider advocate, our mission is to help independent providers like you fight back against unfair claims practices, recover what you've rightfully earned, and protect your financial future. We bring extensive knowledge and regulatory expertise to level the playing field. We specialize in leveraging ERISA law, state and federal protections, and payer accountability measures to recover denied and underpaid claims and protect your practice from recoupment abuse. We don't just submit appeals--we build defensible cases, push back with precision, and pursue every available path to maximize your reimbursements.


We're not here to just submit appeals and hope for the best--we're here to strategically fight back against unfair claims practices and get results. You've worked too hard to let revenue slip through the cracks because of payer tactics built to wear you down. You don't need to become a legal expert or spend hours futilely arguing with payers. You just need someone who knows how to fight back--and win. Let MedClaim Alliance be that advocate for you.


How ERISA Can Help You Get Paid


ERISA, the Employee Retirement Income Security Act, is a federal law that primarily governs employer-sponsored benefit plans, including health insurance. It sets guidelines for plan administration and includes provisions for the appeals process when claims are delayed, denied, or underpaid. ERISA plays a significant role in healthcare claims, as approximately 83% of commercial-managed healthcare plans fall under its jurisdiction, rendering them exempt from most state insurance regulations.


This means that the appeals process for ERISA health claims follows a different set of rules, often unfamiliar to healthcare providers and billers. It's crucial to understand ERISA regulations to recover challenging denied, delayed, and reduced medical claims. That's why we remain committed to helping independent practices navigate these challenges and effectively leverage ERISA regulations--turning complex claim denials into successful recoveries and ensuring they receive the proper and full reimbursements they deserve.


What Sets Us Apart


Unlike most revenue recovery providers in this field, who primarily address contractual and billing errors, we specialize in successfully challenging and overturning payers' unfair claim reduction/denial tactics. We utilize regulatory-based appeals that leverage federal and state insurance laws and payer accountability requirements--so you can recover revenue that other service providers overlook. And while most other revenue recovery providers prioritize hospitals and large healthcare systems for their lucrative potential, our passion lies in defending the underdog--independent practices like yours. We're dedicated to unlocking uncollected revenue and securing financial success for those who often get overlooked. And our revenue recovery service fees are contingent on successful recovery. No recovery, no fee--your success is our success.


With a relentless focus on helping independent practices thrive, we offer unparalleled expertise and personalized solutions to ensure your rightful share of revenue is recovered, propelling you toward lasting prosperity.


The First Step Toward Recovery

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Don't let payers' unfair tactics undermine your practice's financial health. From navigating complex ERISA regulations to overturning aggressive payer audits and recovering lost revenue, we provide expert, regulatory-based solutions to help independent practices like yours reclaim what you're rightfully owed and protect future reimbursements.

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Are you ready to defend your revenue and fight back against payer abuse? Let's talk.

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