Out Of Network

Identification and Recovery

Zero Risk. Maximum Reimbursements.

Wakefield is the leading provider of solutions that help providers maximize payor reimbursements, reduce patient billings, and eliminate the hassle of dealing with insurance companies. Insurance companies have rigged the system against providers to make it difficult to generate fair reimbursements, using a variety of questionable tactics to identify and limit payments on out-of-network bills to only a fraction of billed charges. With extensive knowledge of out-of-network payor strategies, Wakefield has developed a unique approach that works alongside your billing team to optimize out-of-network payments and re-pricing out-of-network bills.

Schedule a quick 15-30 minute call with us for a free consultation to determine your healthcare organization’s needs!

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Lost Revenue Recovery

We are SUCCESS-BASED

NO upfront costs
NO minimums
NO cancellation fees
NO software required
We are a success-based company. If you don’t get paid on your out-of-network claims, neither do we – which means we work even harder to identify and recover reimbursements on your out-of-network claims.

Upfront Recovery: Negotiations Service

Out Of Network

When 3rd party vendors reach out to negotiate an upfront settlement, we step in using our proprietary data to maximize these reimbursements. Our typical providers have seen an average increase of 59% from initial offers! Some providers will see reimbursements as high as 90% of charges!

Post-Payment Recovery: Appeals Service

Wakefield utilizes technology & specialized expertise to comb through payor portals, EDI feeds, and EOBs to identify denials, underpayments, and 3rd party priced claims. We then use our proprietary data to challenge the pricing decision and recover you more money. On average we increase our clients’ initial payments by 87%!

CRXIS

To get our high yielding results, we rely on CRXIS, which stands for Wakefield Information Systems. This is the proprietary data and analytics tool we’ve developed to support us as we go toe-to-toe with payors. CRXIS is the largest health data network in the industry, and helps analyze insurance policies, provides comparable data, and allows us to track the tendencies and trends of the people on the side of the insurance companies and cost-containment vendors.

Our Expertise

Out Of Network

We have over 20 years’ experience in the industry. We’ve built a unique team of experts who worked directly for the largest cost containment vendors and insurance companies, giving us the unique ability to understand their strategies and motives which allows us to stay ahead and get higher payments on bills for our customers. Our team offers advanced workflow processes to successfully navigate the complicated regulation surrounding the reimbursement processes.

Still Unsure? Watch How We Recover Millions...

Don't Let The Payors Limit Your Reimbursements!

We level the playing field, one claim at a time.

We offer a dedicated task force that can help you uncover thousands of dollars in new revenue by identifying underpayments & denials to be negotiated or appealed. No matter your claim type, Wakefield works across several payors to ensure that every claim is reviewed, denials and underpayments appealed, and the first & additional payments reconciled to ensure that you are getting all the payments you’re entitled to.

With our no-risk approach, it’s a no brainer.

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Legacy Conversion

Faqs

Legacy conversion refers to the process of moving data, operations, and functionalities from an outdated or inefficient system to a newer, more advanced system. This transition is crucial for several reasons:

  1. Enhanced Efficiency: Modern systems are developed with the latest technologies, offering faster processing times and more intuitive interfaces.

  2. Improved Compliance: New software systems are often designed to comply with current regulations and standards, helping your organization stay compliant.

  3. Better Data Management: Advanced systems provide superior data management capabilities, allowing for more accurate and accessible patient or customer information.

  4. Increased Productivity: With updated features and fewer system downtimes, employees can work more efficiently, significantly boosting productivity.

There are three primary methods of system conversion: direct conversion, phase-in conversion, and parallel conversion.

  • Direct Conversion: This approach involves completely switching from the old system to the new system at once. It’s fast but carries higher risk if the new system fails.

  • Phase-in Conversion: Here, the new system’s features are gradually implemented over time. It reduces risk but can prolong the total time to full implementation.

  • Parallel Conversion: Running both systems simultaneously for a period ensures the new system operates correctly before fully transitioning. It’s the safest method but can be resource-intensive.

Choosing the right method depends on your organization’s risk tolerance, resource availability, and how critical the system is to your daily operations.

AR Clean-Up is a critical component of the legacy conversion process, ensuring that your accounts receivable management doesn’t falter during the transition. It involves:

  • Reviewing and reconciling outstanding accounts receivable.

  • Identifying and correcting any discrepancies.

  • Streamlining collection processes to improve cash flow.

Implementing AR clean-up before, during, and after a legacy conversion helps maintain financial stability and ensures that your organization doesn’t lose track of owed revenues during the transition.

The main challenges of legacy conversion include data loss, system downtime, employee resistance to change, and budget overruns. To mitigate these challenges:

  1. Thorough Planning: Develop a detailed conversion plan that includes risk assessment and mitigation strategies.

  2. Data Backup: Ensure all data is backed up before beginning the conversion process to prevent loss.

  3. Employee Training: Invest in comprehensive training programs to reduce resistance and ease the transition for your staff.

  4. Budget Management: Allocate resources wisely and plan for unforeseen expenses to avoid budget overruns.

Wakefield specializes in legacy conversion and AR Clean-Up, providing tailored solutions to meet your specific needs. Our services include:

  • Expert Planning and Implementation: We offer strategic planning and implementation support to ensure a smooth transition.

  • Custom AR Clean-Up Projects: Our team tailors AR clean-up projects to fit your organization’s unique requirements, improving your cash flow and accounts receivable management.

  • Training and Support: We provide comprehensive training for your employees to help them adapt to the new system quickly and efficiently.

By partnering with Wakefield, you can ensure that your legacy conversion and AR clean-up processes are managed effectively, allowing your staff to focus on learning the new system without fear of reduced collections or financial instability.

Planning, testing, and training are key phases that can affect the overall timeline. Engaging with a professional service like Wakefield can help streamline the process and reduce downtime.

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