What We Do

Recovering and financing underpaid out of network claims for healthcare providers

Through a combination of multidisciplinary strategy, proprietary data analysis, and provider and claim bundling, Allia Group can identify which claims will result in the highest yield and have the greatest financial impact.

Over the past 14 years, our analysis has indicated that out-of-network claims are underpaid by as much as 80 percent—this means providers are only receiving 20 cents for every dollar of service rendered. Not only is underpayment harmful to providers, but it can have significant financial consequences for the healthcare business model.

By leveling the playing field and recovering revenue at scale, we restore the balance of power between insurance carriers and healthcare providers—many of whom have been forced to navigate this power struggle alone.

Physician
Groups

Physician Management Firms

Hospitals

EMS Companies

Allia Group offers several structures to fit providers’ financing needs, whether the provider needs immediate cash flow or prefers to receive payments over time as additional claims are settled and processed

Financing solutions

Immediate liquidity structure

This structure provides immediate cash flow to providers who prefer to benefit from the prompt disbursement of capital. Once the underwriting process is complete, the provider receives capital at the beginning of the claims purchase.

Incremental payment structure

Allia Group purchases claims based on a percentage of what is recovered at the completion of the settlement and litigation process for each carrier. Then providers are paid on an incremental basis as claims are received from different carriers over time as cases are settled.

Hybrid structure

This structure is ideal for providers that need both immediate cash flow and want to continue receiving payments from additional settlements. This option includes an advance of the projected recovery at the beginning of the claims purchase and additional payments as carrier litigation and settlements are complete.

How we optimize revenue recovery

Data analysis

From our specialized data warehouse, Allia Group analyzes thousands of bills and sorts them using our proprietary algorithms to determine which claims were underpaid and which can have a material recovery. This data analysis is also used by our legal strategy team to determine which claims can be combined with other provider claims to litigate most effectively.

Bundling

Next our firm analyzes claims between providers to find similarities and bundle underpaid claims into cases against specific insurance carriers. This allows Allia Group to formulate the best possible case strategy and maximize settlements throughout litigation. Aggregating a high volume of claims has sharpened Allia Group’s expertise with maximizing revenue from all types of health insurance companies—from large to small, local and regional.

Litigation

Allia Group has a substantial track record successfully litigating and settling out of network cases. Our case history and proprietary litigation model provide a barometer from which we determine how to litigate, what strategies will be most effective, and where to accelerate the settlement process.