ClaimReturn

ClaimReturn LLC is a medical claims analytics and recovery service specializing in identifying and recovering overpaid healthcare claims. The company positions itself as an early adopter of AI technology in medical claim analytics, using proprietary algorithms to detect improper payments, coding errors, and billing discrepancies in healthcare plan administration.

The firm offers three primary service models: post-payment overpayment identification only (flat fee), post-payment identification with recovery (contingency basis), and pre-payment SaaS validation through an integrated client portal. Their approach combines AI-powered auditing with expert human review, supported by comprehensive reporting dashboards that track recovery progress and help prevent future overpayments.

ClaimReturn has documented significant recoveries in case studies, including $2 million from dialysis coding overcharges, $1.8 million from anesthesia rate overpayments, and $1.6 million from ICU service bundling errors. The company emphasizes minimizing provider, plan, and member abrasion during the recovery process while maintaining HIPAA compliance and professional certifications through AAPC, AICPA, and HCAA partnerships.

Organizations should consider ClaimReturn when they need to validate historical claims accuracy or suspect systematic overpayment issues. Their contingency-based recovery model makes them particularly attractive for organizations wanting to explore overpayment potential without upfront investment.

Expect a data-driven engagement where ClaimReturn uploads claim files, runs AI-powered analysis, and presents findings with supporting documentation. Their case studies suggest particular strength in identifying coding errors, rate discrepancies, and bundling issues across dialysis, anesthesia, and infusion services. The pre-payment SaaS option offers ongoing validation for organizations wanting to prevent future errors.

ClaimReturn operates exclusively in healthcare payment integrity, focusing specifically on medical claims overpayment identification and recovery for health plans and plan sponsors. Their expertise centers on medical coding validation, contract compliance verification, and billing error detection across multiple healthcare service areas including dialysis, anesthesia, ICU, and infusion services.

The company maintains HIPAA compliance and partners with healthcare-specific professional organizations including AAPC (coding), HCAA (healthcare auditing), and SHRM (benefits administration), demonstrating deep domain knowledge in healthcare claims management and plan administration.

The ideal client is a mid-to-large health plan, TPA, or self-insured employer with substantial claims volume (likely processing thousands of claims monthly) who values data-driven overpayment identification. Organizations concerned about provider relationship preservation during recovery efforts will appreciate their stated focus on minimizing abrasion throughout the process.