Uniquely Qualified in Managed Care, Hospital & Insurance Management

Case Management Covenants, a leading provider of hospital and healthcare consulting services, focuses on the resolution and recovery of denied medical claims. With more than 100 years of combined healthcare and Managed Care experience, CMC is uniquely qualified to leverage its expertise to recover 45% - 60% of your lost earnings. Our highly experienced team of physicians, nurses and claims operations consultants is specially trained to manage the entire appeals process, from deciphering the exact denial reason, or crafting a powerful medical necessity argument, to navigating through the bureaucratic and compliance complexities that is typical of payor and regulatory appeals processes.

High Impact - High Touch Management Approach

CMC partners with hospitals and other healthcare providers to manage every facet of the appeals management process, from denial identification through the appeal process until the claim is finally paid. CMC’s proprietary “High Touch – High Impact” process accelerates the denials management process, yielding more than double the recovery dollars typically obtained by other appeals management systems.

Medicare RAC appeals

CMC is uniquely positioned to help our hospital clients successfully manage their RAC appeals. Our history of successfully managing all types of appeals speedily and efficiently, our intimate knowledge of CMS National Coverage Determinations and inpatient approval criteria, our strong reporting capabilities and our team of dedicated highly qualified Medical management experts will guarantee the maximum possible recovery rate on your RAC denials.

Value Added Services

CMC automates each denial it receives and enters the data into its proprietary High Touch – High Impact Appeals Management System. This process not only serves the recovery team, but also produces actionable data our clients use to enhance the processes that prevent denials from occurring in the first place.

• Appeals Management Reporting - provides a status of all claims received and disposition through processing.
• Root Cause Management Reporting - provides detailed actionable data on denials by physician, diagnosis and reasons for denials.
• Denial Management Training - based on data uncovered in reporting, training can be provided to minimize the percentage of denied claims moving forward.