Complex Claims Require More Than Standard Billing.
Expertise and technology purpose-built to master complexity. Designed to accelerate recovery, reduce receivables risk, and improve outcomes on claims standard billing processes struggle to resolve.
A Hidden Revenue Risk
Motor vehicle accidents, workers' compensation, VA programs, and Medicaid eligibility — complex claims represent a relatively small volume but drive outsized receivables risk. They require specialized expertise, dedicated workflows, and a partner built specifically for the problem.
Built Around Complexity: Expertise, Technology, Results
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Legal & Reimbursement Expertise
Dedicated teams for MVA/TPL, Workers' Comp, VA, and Medicaid Eligibility & Enrollment with deep regulatory, clinical, and legal knowledge that standard billing teams don't carry. Attorney-informed workflows with built-in escalation for contested claims.
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Proven Complex Claim Recovery
Proven value delivering 400%+ ROI for WC and MVA and ~15x ROI for VA. Higher payment rates of 90–95% across WC and VA. Faster resolution, from under 20 days for VA claims to under 45 days for MVA.
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Proprietary Technology
ReClaim™ applies 87,000+ workflow rules — automating payer discovery, compliance enforcement, and claim routing from intake through final resolution. Same-day payer identification in most cases.
End-to-End Ownership, from Identification to Cash
Identification at Day One
Claims are identified immediately after discharge using ICD-10 codes, accident indicators, and veteran status flags — then automatically routed to MVA, WC, or VA specialist teams. Direct integration with Epic enables Day 1 identification without manual intervention, so no complex claim enters the revenue cycle undetected or misrouted.
Payer Discovery & Verification
Our proprietary Accident Payer Search (APS) identifies applicable coverage — including PIP, MedPay, property & casualty carriers, WC employers and TPAs — often within seconds of intake. APS links 6,000+ employers to their correct WC carrier, eliminating the manual research that stalls most programs. Coverage is confirmed before billing begins, protecting lien rights from day one.
Compliant Billing & Resolution
Over 87,000 rules enforce correct billing order, COB logic, WC fee schedules, and VA documentation requirements — minimizing rejections and protecting lien rights. Payer-specific follow-up cadences, deadline alerts, and automated escalation prevent claims from aging. Payments are then validated against applicable fee schedules; underpayments are flagged, and results reconcile daily back to your EHR.
Four Distinct Programs. One Specialized Partner.
MedPay, PIP, liability, and attorney-driven settlements with in-house lien management and attorney negotiation. Same-day payer identification through our proprietary Accident Payer Search engine.
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Automated claim identification with routing to Auto, WC, or VA specialists.
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Proprietary Accident Payer Search (APS) engine identifies applicable coverage within seconds.
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87,000+ billing rules enforce correct COB logic, WC fee schedules, and VA documentation requirements.
Full lifecycle management — from employer and TPA discovery through fee schedule validation and contested claim escalation. Attorney negotiation and legal escalation are handled in-house; no external referral required.
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Automated claim identification with routing to Auto, WC, or VA specialists.
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Proprietary Accident Payer Search (APS) engine identifies applicable coverage within seconds.
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87,000+ billing rules enforce correct COB logic, WC fee schedules, and VA documentation requirements.
Community Care Network, Optum Serve, TriWest, and TRICARE — with same-day authorization verification and VA-specific billing compliance built in. Faster resolution: under 20 days for VA claims on average.
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Automated claim identification with routing to Auto, WC, or VA specialists.
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Proprietary Accident Payer Search (APS) engine identifies applicable coverage within seconds.
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87,000+ billing rules enforce correct COB logic, WC fee schedules, and VA documentation requirements.
Medicaid, Medicare Savings Programs, SSI/SSDI, ACA Marketplace, VA benefits, workers' comp, COBRA, and SNF/LTC — with bedside screening before discharge and full case ownership through final approval. No handoffs, no gaps.
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Automated claim identification with routing to Auto, WC, or VA specialists.
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Proprietary Accident Payer Search (APS) engine identifies applicable coverage within seconds.
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87,000+ billing rules enforce correct COB logic, WC fee schedules, and VA documentation requirements.
Case Study: Great River Health
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Challenge
Great River Health was managing complex claims across MVA, Workers' Comp, and VA — internally and with other vendors. The team was committed to maximizing reimbursements but recognized that the specialized demands of these claim types warranted a more focused approach than a generalist program could deliver.
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Solution
After evaluating options, Great River Health selected Revecore based on its implementation track record and auto claims expertise — starting with hospital technical billing and expanding the partnership to Workers' Comp, professional billing, and VA service lines as results confirmed the value. The Great River team drove the expansion decisively, moving quickly when each phase performed.
Results
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$51M recovered across auto, Workers' Comp, and VA service lines
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WC recovery rate increased from 40% to 69%
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Billing staff refocused on higher-value work as complex claims moved to a dedicated specialist
What Generalist Vendors Can't Replicate
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25+ Years of Proven Expertise
Attorney-founded and purpose-built for non-traditional payers, with 25+ years of expertise and built-in legal escalation for MVA and WC.
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Power of 1,300+ Hospitals
Network intelligence built from cross-client payer behavior and claims data across 1,300+ hospitals — sharpening detection for every client.
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Purpose-Built for Complexity
87,000+ rules. Not a general RCM system with a complex claims module — a platform engineered specifically for what standard tools can't handle.
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Dedicated Specialist Teams
MVA, WC, VA, and Medicaid E&E specialists averaging 10 years in specialty reimbursement — with in-house legal escalation, no referrals.
Proven Performance Across Complex Claims
$1.8B
Revenue recovered on behalf of clients in 2025.
Up to 70%
Reduction in complex claim A/R.
30-50%
Higher reimbursement on complex claims.
50-70%
Faster cash flow versus in-house performance.
Frequently Asked Questions
What types of claims does Revecore handle under Complex Claims?
Revecore manages MVA/Auto TPL, Workers' Compensation, Veterans Affairs programs, and Medicaid Eligibility & Enrollment — each requiring payer discovery, multi-party coordination, and specialized regulatory and billing knowledge.
Why do complex claims represent such a disproportionate financial risk?
Complex claims are 3-5% of volume but drive 15-20% of receivables risk. They require 3-5x more staff time than standard claims, and hospitals write off 10-15% of these balances due to administrative burden alone.
How does Revecore identify complex claims at intake?
Claims are identified at Day 1 using ICD-10 codes, accident indicators, and veteran status flags through direct Epic integration. Automated routing assigns claims to MVA, WC, or VA specialists — no manual intervention required.
Does Revecore handle legal escalation in-house?
Yes. Attorney negotiation and lien management for MVA/TPL are handled internally. For contested WC claims or complex VA rejections, escalation to senior legal staff occurs within Revecore's operating model with no external referral required.
Find Out What Complex Claims Are Costing You.
Connect with a Revecore specialist to benchmark your complex claims performance and identify where recovery is being left on the table.