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ERISA RECOVERy
ERISA Recovery
The Employee Retirement Income Security Act (ERISA) became a law in 1974 to protect pension plans in private industry, but its regulatory scope has expanded to healthcare. Today, ERISA is considered the most powerful appeals method for commercial claims that have been denied or underpaid. Experts at Ensource’s ERISA Commercial Claims Recovery will help you to maximize the reimbursements you’re properly due. We’ll handle your appeals quickly and increase your revenue.
Examples of Recent ERISA Denial Successes:
$1.2 million recovered for an in-network New York hospital that was denied the use of Alloderm for breast reconstruction surgery.
The health plan denied 250 claims, asserting Alloderm was “experimental/investigational.” ERISA appeals based on the Women’s Cancer Rights Act, language from the employer’s Summary Plan Description, and the health plan’s own internal policy resulted in full reimbursement.
$350,000 recovered for an in-network Wisconsin hospital denied for emergency implantation of a pacemaker.
The health plan denied the claim as “medically unnecessary,” and a first appeal was denied by an OB/GYN registered nurse. The ERISA appeal cited violations based on the appeal review of a cardiac case by an OB/GYN registered nurse.
$1 million recovered for an out-of-network implantable device supplier.
A health plan denied numerous claims asserting that out-of-network implantable devices were an “excluded/non-covered” service. ERISA appeals efforts reviewed Summary Plan Descriptions from several employers involved—none precluded out-of-network implantable device suppliers from billing for their services.
$750,000 recovered both for anesthesia services provided by a CRNA and for the use of Propofol.
A health plan denied several claims over two years asserting that the CRNA’s services were not covered under a state employer-based plan. The ERISA appeal proved that the Summary Plan Description did not exclude services rendered by a CRNA nor did it exclude Propofol.
ERISA is a very complicated process for appeals but can be well worth the effort with a high ROI. If your current appeals process is not yielding the results that you want and deserve, you should consider engaging an expert in ERISA for your appeals. Enource’s ERISA Recovery Experts are ready to help you earn what you are allowed under appeals. Elevate your ERISA recovery – it will be worth your efforts.
Benefits of ERISA Recovery
Navigating claim denials and underpayments can drain valuable time and resources. Ensource’s ERISA Recovery services give providers a proven path to reclaiming lost revenue, improving cash flow, and strengthening their financial stability while avoiding extra strain on the internal team.
No Upfront Costs
Engage Ensource’s ERISA Recovery services with no financial risk. Fees are based only on the dollars successfully recovered.Expert Advocacy
Ensource’s US based team of certified coding and compliance professionals navigates complex ERISA regulations and appeals with proven expertise.Custom and Scalable Solutions
Whether you need targeted appeals or a virtual appeals department, Ensource tailors services to align with your revenue cycle strategy.
At Ensource, we understand the complexities of denial management and offer tailored solutions to help healthcare organizations navigate these challenges effectively. Our team of experts are dedicated to improving your revenue cycle through comprehensive denial management strategies, ensuring your focus remains on delivering exceptional patient care.
Real Client Testimonials
Why choose Ensource?
FREQuently Asked Questions (FAQS) about Erisa Recovery
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Ensource targets healthcare providers dealing with denied or underpaid commercial claims. Their team, staffed with credentialed coding experts, uses ERISA to recover proper reimbursements, streamlining the appeals process with high ROI in mind.
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Ensource stands out through:
A team of fully credentialed, U.S.-based coding experts.
Customized services tailored to each client’s revenue cycle needs.
High integrity, compliance, and on-time delivery.
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Typically, clients provide standard revenue cycle reports from their system. Ensource then:
Identifies ERISA appeal opportunities (often using data analytics).
Crafts and files targeted appeals.
Executes handling end-to-end with minimal impact on client operations.
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No—Ensource’s approach to ERISA recovery often involves no upfront fees. Clients benefit from full appeals services and only invest once recoveries are realized.
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Clients typically see substantial financial returns:
Recovery amounts averaging $1 million or more within the first 90 days.
Creation of an effective "virtual appeals department" without internal staffing burdens.
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Ensource: YOUR TRUSTED PARTNER MEDICAL CODING
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