Your Ally in Combating Unfair Claims Practices


Helping Independent Practices Remain Independent



Frequently Asked Questions





1. Do you need to visit our practice or billing office?

Not at all. All our services are handled entirely in-house. No on-site visits are required.


2. What types of medical claims can you help with?


Send us any claim challenge--private or public payer--and we'll let you know exactly how we can help. However, we do not handle claims that have simply been rejected due to billing errors or lack of information, like medical notes. Those can be easily resolved by your billing team, and there's no need for regulatory-based appeals.




3. What types of independent practices do you assist?


We proudly support all types of independent healthcare providers and practices across the U.S., whether you're a solo practitioner or a multi-specialty group.




4. What size of independent practices can you help?

Our primary clients are small to mid-sized practices. However, we're fully committed to helping any practice in need, and we're open to making customized arrangements to support larger independent practices when possible.



​​5. Does it matter if we are in-network or out-of-network?




No. We assist with both in-network and out-of-network claim issues.




6. What are your fees?


Other than our claims recovery fees (25% of recovery), all other fees are structured by the scope and complexity of the case, and we will charge either by the hour or per job. Also, we've designed our pricing to work for practices of all sizes, so even solo providers can access affordable, high-quality claims and advocacy support.





7. What makes you different from typical claims recovery vendors?


While most claims recovery vendors focus on contractual and billing errors, we specialize in challenging payer tactics that unjustly reduce, delay, or deny reimbursements. Very few vendors have the in-depth knowledge of ERISA and regulatory insight to recover full and proper reimbursements the way we do. We don't just manage denials--we fight them. Beyond claims recovery, we also offer specialized provider advocacy services designed to maximize and protect revenue while reducing administrative burdens.




8. Are you HIPAA compliant?

Absolutely. We operate fully within HIPAA regulations and maintain secure, compliant processes for all Protected Health Information (PHI). We provide a Business Associate Agreement (BAA) to every provider we work with, ensuring full legal protection and peace of mind.






9. What is ERISA and why does it matter?


ERISA (Employee Retirement Income Security Act of 1974) is a federal law that governs most employer-sponsored health plans. Many providers and billers mistakenly assume state insurance laws apply to all claims--but in reality, over 80% of commercial claims are ERISA-governed.



ERISA gives providers the right to appeal denials, request plan documentation, and hold payers accountable to federal standards.






10. How do I determine if a health plan is governed by ERISA?

The easiest way to identify if a health plan is an ERISA plan is to first determine if it's offered through an employer. It doesn't matter if it's PPO, HMO, POS, etc. All health benefit plans provided by an employer engaged in commerce are ERISA plans so long as the employer is not government (federal, state, county, or city) or a religious organization. Look on the patient's insurance card for "Self Funded" or an employer's name. You can even call the number on the card and ask if the plan is governed by ERISA.


ERISA does not cover Medicare, Medicaid, governmental, school, church, workers' comp, military, and individual plans.




11. Does it matter if our billing is in-house or outsourced?


Not at all. We integrate seamlessly into your existing workflow with no process changes and no headaches. Under your business name, we serve as your external Claims Resolution Department, handling the heavy lifting while your billing team continues business as usual.


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