Ai Medicare Advantage Collections

Currently Serving

Nephrology • Oncology • Vascular Surgery • Wound Care
(More specialties coming soon.)

Why start with these four?

Because they take the brunt of Medicare Advantage friction: heavy prior auth, strict medical-policy edits (dialysis logistics, chemo/radiation regimens, skin substitutes, endovascular procedures), and documentation traps.

In our pipeline, these groups consistently show the largest recoverable backlogs.

Real-world example: we’re assisting a multi-site nephrology group with ~$103 million in previously unapproved MA claims. It’s not a unicorn—this is what years of denials + “we’ll get to it later” looks like.

Statistics show…

Medicare Advantage (MA) = denial friction. Roughly 6.4% of MA prior-auth requests were denied in 2023—~88% of those denials were never appealed.
Many denials are actually payable. Federal audits found ~13% of MA prior-auth denials and ~18% of MA payment denials met Medicare coverage/billing rules (i.e., should have been approved/paid).
Initial claim denials are common. Large-scale analyses peg ~17% of MA initial claims as denied; even after reversals, provider payouts end up ~7% lower than they should—pure friction cost.
A/R aging tells the story. Traditional Medicare (FFS) is fastest (≈11–12% unpaid >90 days). Commercial is slowest (≈31–32% >90 days). MA behaves closer to commercial than to FFS, which is why your 90+ and 120+ buckets swell.
Healthy benchmarks. Well-run practices aim for A/R >90 days ≤ 15% and Net Collection Rate ≥ 95%. Every 1% below 95% NCR on $5M of net collections = $50,000 left on the table—every single year.

What this means for you: If your practice collects $6M/year and you’re sitting at 20% in 90+ A/R with 35% MA mix, there’s a realistic $80k–$170k in recoverable MA cash from the aging stack alone—before we touch the last 1–4 years of denials you never had time to appeal.

How We Help

Our purpose-built AI does the heavy lifting. It ingests your remits, prior auths, and charts; cross-checks CMS/plan policies; builds audit-ready evidence packets; and resubmits/appeals—with minimal staff time.

Near-100% success when the record is complete. When required documentation exists (and prior auth was obtained where needed), our win-rate on eligible claims has been effectively 100% in our engagements.
Zero upfront cost. We work contingency-only—our fee is a percentage of what we recover. If we don’t collect, you don’t pay.
Up to 4-year lookback. If the service is documented and at least one timely submission/appeal occurred, we can pursue it.
Ethical documentation support. The AI can clarify and organize physician notes (grammar, structure, linkages to medical necessity) without altering clinical facts, and preserves a complete audit trail.
30-minute decision call. One focused conversation with your decision-maker(s) answers how it works, what we need, and when you’ll see cash. For many practices, it feels like finding a winning lottery ticket in their A/R drawer.

Reach out to the person who referred you here to set up your phone call with our experts to answer all your questions and get you started.

Success depends on payer contracts, documented medical necessity, timely-filing/appeal status, and record completeness. Statistics above reference publicly available analyses from KFF (2023), HHS-OIG audit findings, MGMA/HFMA benchmarks, and recent peer-reviewed health-policy research. Results vary by practice and payer.