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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