What to send, after the first call
The review turns on dates. Most of what we ask for lets us place each charge against the one-year-back rule, the 30-day payment clock and the insurer’s denial history.
| Item | What we use it for |
|---|---|
| Aging report by date of service, not by billing date, with patient, crash date, insurer, claim number, CPT or HCPCS codes, billed, paid, adjusted and balance | Sorting charges by how close they are to the one-year-back line |
| EOBs and EORs for open claims | Checking fee-schedule math, reductions and partial payments |
| Denial letters, utilization review determinations and IME-based cutoffs, with the date each was received | Tolling under MCL 500.3145(3), the 90-day DIFS appeal window, and the reason for each denial |
| Intake forms: assignment of benefits, authorizations, financial responsibility forms | Deciding between a direct claim and an assignment, and spotting assignments that cut off your own claim |
| Insurer list, with the number of open patients and total balance for each | Planning batch filings by insurer |
| Funding or factoring agreements, if any receivables were sold or pledged | Confirming you still own the claims after C-Spine Orthopedics v. Progressive (2025) |
| Your January 1, 2019 charge master, for services Medicare does not price | Applying the 52.5% formula and the average-charge ceiling |
| Proof of submission for a sample of bills: clearinghouse reports, portal receipts or fax confirmations | Fixing when reasonable proof arrived and when 12% interest began |
Home care agencies should add the rate each insurer paid by service type, so we can compare it with the Medicare-based cap after West Michigan Home Care v. MEEMIC. Surgeons and surgery centers should flag any claims denied after an insurer medical exam.
How the review works
- You use the form below. Tell us your practice, a contact, and a rough unpaid balance. Do not include patient information in the form.
- We set up a secure transfer. Patient-level files are protected health information. We arrange a secure method to receive them, and you can ask about a business associate agreement before sending anything.
- We triage the aging. Every open charge goes into one of four groups: expiring soon, collectable, needs documents, or not worth pursuing. We look for one-year-back exposure first because it is the only problem that gets worse every day.
- We check the denials. We sort them by reason: insurer exam, utilization review, fee-schedule reduction, priority dispute, rescission, missing records or eligibility. Each points to a different remedy.
- We report back. You get a written summary by insurer of what we recommend, including which claims to file first, which to appeal to DIFS, and which documentation gaps to fix in your billing process.
- You decide. If you want us to proceed, we sign a written engagement agreement that sets the contingency fee before any demand or suit goes out.
What the review will not tell you
We do not quote recovery percentages or dollar amounts. Results depend on facts that differ claim by claim: whether reasonable proof was received, how the fee schedule applies, whether a denial was reasonable, and whether the insurer can show fraud. What we can tell you is which claims appear supportable on the documents, what is missing, and which deadlines are closest.
Before you send anything
- Pull the aging as of a fixed date and note it, so dates line up with our analysis.
- Include zero-paid and partially paid claims. Partial payments are often where fee-schedule errors hide.
- Do not write off balances because an insurer said “final.” A denial starts the one-year clock running again; it does not end your right to sue.
- If an insurer has sued you or a patient’s policy is being rescinded, say so up front. See rescission suits that name providers.
The oldest dates of service on your aging are the ones closest to the one-year-back line. Use the form below to start the review.
Sources: MCL 500.3112, 500.3142, 500.3145 and 500.3157; Mich Admin Code R 500.65; 45 CFR 160.103 (definition of business associate); C-Spine Orthopedics, PLLC v Progressive Mich Ins Co (Mich, July 3, 2025); West Michigan Home Care Services, Inc v Meemic Ins Co (Mich App, Oct 20, 2025).
Questions people ask us
Is there a minimum balance?
Yes: $3,000 in total unpaid or disputed no-fault balances. The total can be spread across many patients and insurers, so a practice with many small balances usually qualifies.
Does the claims review cost anything?
No. We review your aging and tell you what we think is collectable before you sign anything. If you hire us, provider collections are handled on a contingency fee set out in a written agreement before we file; case costs are advanced by the firm and repaid only from recoveries. The full terms are on our main page for medical providers.
Should we email patient records through the form?
No. Use the form only for contact details and a rough balance. Patient-level data is protected health information, and we will arrange a secure way to receive it. HIPAA treats a law firm that receives protected health information to provide legal services to a provider as a business associate, so ask about a business associate agreement first.
Will you tell us how much we will recover?
No, and you should be wary of anyone who does. Recovery depends on the insurer, the denial reason, the fee schedule, the one-year-back rule and the evidence on each claim. We tell you which balances are collectable and why.
What if our aging report is a mess?
Once the secure transfer is set up, send what you have. A raw export from your practice management system is fine. We need dates of service more than we need a clean format.
