Claims Investigation & Revenue Recovery
Medical Aid Revenue Recovery
A template case study describing the type of claims work performed for practices. All information is anonymised.
Work performed
What Claims Investigation Involves
Structured review, investigation and follow-up on outstanding medical aid revenue.
- Reviewing remittance statements
- Identifying unpaid claims
- Analysing rejection reasons
- Investigating billing issues
- Tracking outstanding claims
- Preparing queries
- Resubmission support
- Following up with medical schemes
Not sure how much revenue is sitting in rejected or unpaid claims? The guided assessment scopes it.
Request a Practice AssessmentRevenue Recovery in Practice
From Unpaid Claims to Structured Follow-Up
A six-step methodology applied to anonymised claims data. No patient or membership information is ever displayed.
- 01
Review Remittances
Analyse available remittance information and payment outcomes.
- 02
Identify Outstanding Claims
Identify unpaid, rejected or problematic claims requiring investigation.
- 03
Analyse the Reason
Review available rejection reasons, billing information or submission issues.
- 04
Investigate & Correct
Identify the appropriate next action, which may include correcting available information or preparing a query.
- 05
Resubmit or Follow Up
Where appropriate, support resubmission or follow-up processes.
- 06
Track the Outcome
Monitor progress and maintain visibility over outstanding matters.
Claim outcomes depend on multiple factors, including claim validity, scheme rules, available documentation, submission requirements and other relevant circumstances. Recovery cannot be guaranteed.
Confidentiality
Patient names, membership numbers, ID numbers and other POPIA-protected information are never displayed publicly. Examples shared with prospective clients are anonymised.
Outcomes
Results depend on scheme rules, claim age and the accuracy of the original submission. We do not publish recovery percentages or guarantee outcomes.
Every recovery engagement starts with the same 5-step practice assessment.
Request a Practice Assessment