Callagy Law has had tremendous success in its pursuit of Personal Injury Protection (PIP) claims on behalf of its medical provider clients. Indeed, over the course of the firm’s history, Callagy Law has recovered tens of millions of dollars for our medical providers. This has been due in large part to the process used by the Firm to identify and pursue medical claims. Without divulging any of our secrets to success, we present below some of the Firm’s procedures that give a fairly broad sense of why we are successful at aggressively pursuing our clients’ claims.
The process starts with Callagy Law’s team of liaisons. Our client liaisons interact, to varying degrees, with our medical providers to identify claims inappropriately denied or underpaid. They are knowledgeable about the methods used by carriers to pay as little as possible to medical providers. Once the liaison reviews the claim, it is “delivered” to our system.
The claim is now a “file” and is scrutinized by our file “scrubbers” who review it to ensure that all the necessary documents are contained in the file, including the assignment of benefits (AOB) and the clinical records in support of the claim. They also investigate whether there is still money available in the policy, and whether there are other pending claims involving other providers with which the current file could be consolidated. After the appeal period or periods, the claim is filed for arbitration.
Once the claim is filed, it goes to our fee schedulers. They are charged with making sure the claim is consistent with any applicable fee schedules. Whether the applicable fee schedule is the Physician’s Fee Schedule, the ASC Fee Schedule or the Hospital Outpatient Fee Schedule, our fee schedulers are there to ensure the arbitration seeks the full amount of reimbursement permitted by law.
The file then goes to our file vetters. Their role is to review the file in preparation for litigation. They assemble any payment proofs that might be helpful, and request additional documents that might be needed, since the file was originally delivered to the firm.
After the file is sufficiently vetted, it goes to our teams of attorneys/arbitration writers. They are the final substantive review of the file. They write the arbitration statement in anticipation of hearing and assemble all of the arguments in support of the claim.
Throughout the above process, Callagy Law’s settlers are in communication with carriers in order to settle our providers’ claims. We resolve a tremendous number of claims through settlement after the claims are filed, which enables us to obtain for our providers as much money as possible as quickly as possible. Of course, these settlements are always at levels approved by the provider.
Between the settlement of claims and an extremely high win ratio after hearing, we provide our medical providers with an extremely effective process for recovering as much money as possible for them as quickly as possible.
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