Credit Balance Solutions

We conduct onsite provider financial reviews of credit balance accounts for over 200 BlueCross BlueShield plans, commercial insurers and managed care plans at thousands of providers nationwide.

Superior services and technology solutions
for healthcare payers

A typical 300-bed hospital generates over $3 million in new credit balances every year. A large teaching hospital or health system can generate over $25 million (50,000+ accounts) in credit balances on an annual basis.

Given the high degree of emphasis on billing and collections, coupled with a general lack of resources, most hospitals experience significant, growing volumes of credit balances that accumulate within their A/R. These unresolved credit balances represent a potential significant source of medical expense recoveries to healthcare payers.

Payers often partner with a credit balance vendor to expedite and maximize credit balance recoveries; however, some healthcare payers are disappointed by the level of performance, lack of provider coverage and/or quality standards of their chosen vendor. Serving thousands of providers, 34 Blue Cross Blue Shield plans and over 150 Commercial and MCO clients nationwide, Credit Balance Solutions offers superior onsite provider staff and technology solutions that set them apart from other credit balance vendors.

Credit Balance Solution’s highly trained staff conducts comprehensive, ongoing reviews of all open credit balances on each provider’s accounts receivable systems and records. All identified credit balances are analyzed and documented and all validated overpayments are presented to the provider for review and approval prior to recovery. Once approved by the provider, Credit Balance Solutions obtains a refund check for the amount overpaid or provides written approval to have the overpayment offset against future provider payments.

Read more about our Renal Dialysis Audits.

What sets our credit balance solutions apart from other vendors?

  • Independence: Credit Balance Solutions is not owned or affiliated with any healthcare payer or provider. The ownership structure alleviates any concerns about potential conflicts of interest and ensures that our payer clients are not funding an industry competitor.
  • Superior Results: Credit Balance Solutions staff typically hold four-year college degrees and are highly trained in credit balance coordination of benefits (COB) rules, provider contract analysis, HIPAA regulations and protected health information (PHI) and data security. Staff goes onsite to the provider location to review all potential credit balances, analyzing their root cause and facilitating their processing.
  • Technology: All Credit Balance Solutions clients receive access to an online credit balance tool called CBAS (Credit Balance Analysis System). The web-based CBAS application allows payers to view open inventories of provider-approved credits, including all supporting documentation and to automatically assign and route claims to processing staff for recovery. CBAS also contains powerful real-time and ad hoc reports that identify root cause, trending and drill-down analysis that populates quickly into meaningful reports.
  • Commitment to client’s business processes and goals: Credit Balance Solutions works with clients to establish a process that meets their business needs and to establish recovery goals and objectives.
  • HIPAA compliant
    • Our process preserves the integrity and confidentiality of all patient PHI. No PHI is is ever removed from the provider location
    • Ensures that only the minimum necessary data is used in order to resolve the credit balance account

Products and services

Credit balance accounts are a natural part of today’s complex reimbursement environment, and recovering these credit balances in a timely manner results in reduced waste and allowed medical expenses for healthcare payers.