Seven questions to ask before handing your claims to any recovery vendor

Handing a file of claims to an outside company is an act of trust. The claims carry protected health information, the work happens out of your sight, and the results arrive as numbers you have to believe.

So the evaluation should not be about the pitch. It should be about the specifics. Here are the seven questions worth asking any recovery vendor, including us, and what a good answer sounds like.

1. How do you get paid, exactly?

Contingency pricing, a percentage of what is actually recovered, is the honest default for this work, because it puts the vendor's incentive exactly where yours is. But the details matter. Ask what the fee is calculated on, what happens when a payment reverses after the fee was charged, and whether there are setup fees, monthly minimums, or termination charges hiding around the contingency headline.

A good answer is short: a rate agreed before work begins, calculated on recovered dollars only, reversals come back out, and nothing else.

2. Which of my claims will you not work, and will you tell me?

This question exposes more than any other. A vendor that accepts every claim is either going to waste effort on money that is gone or quietly ignore the hard ones while reporting activity on the easy ones.

The answer you want is that unrecoverable claims get declined up front, with the reason stated: appeal rights expired, patient responsibility, a contractual write-off with nothing above the rate to pursue. A declined-with-reason list is not a failure of the service. It is the first piece of evidence the service is honest.

3. What will I be able to see while you work?

Recovery work is invisible by default, and invisibility is where trust goes to die. Ask what record exists of each touch on each claim, and whether you can see it without asking permission.

The standard to hold out for is a log: every payer call, portal check, submitted appeal, and document request, recorded with dates and outcomes. When you ask what is happening with a claim, the answer should be a record, not a recollection.

4. If you use AI, who reviews what it produces?

Most recovery operations now use automation somewhere, and that is fine. What matters is where the human sits. Ask three specific things: where does the automation fail, who supervises its output, and who owns the exceptions when a claim does not fit the pattern.

The answer that should worry you is any version of fully autonomous. The answer that should reassure you is specific: nothing reaches a payer without a person reviewing and approving it, ambiguous cases route to a human queue rather than a guess, and payments post only on exact matches.

5. How will you handle my data?

Claim files are protected health information. The floor here is not negotiable: a business associate agreement executed before any data moves, encryption in transit and at rest, access limited to the people doing the work, and a clear answer about what happens to your data if you leave.

Two follow-ups sort vendors quickly. Ask whether they need clinical notes for recovery work; for most of it, they should not, and a vendor that asks for more data than the work requires is a flag. And ask how fast they can complete your security questionnaire. The ones with real controls answer quickly because the answers already exist.

6. How does the statement prove the money?

The statement is the entire relationship reduced to a page, so ask exactly what will be on it. You want to see the individual payments reconciled against remittances, the gross recovered, the fee calculation, and your net, with the ability to export it whenever you want.

Then ask the reversal question again, on the statement this time: when a payer claws a payment back, does it come out of the ledger you see? If the statement only ever goes up, it is a marketing document, not an accounting one.

7. What happens to what you learn about my payers?

This one is rarely asked, and it separates a service from an asset. Every worked claim teaches something: which payers pay on follow-up, which denials overturn, which contract lines run short. Ask whether any of that learning comes back to you in a form that prevents the next round of losses, or whether the vendor's model depends on your pile refilling forever.

A vendor whose economics improve when your denials continue has a quiet conflict of interest. The better arrangement is one where the recovery work feeds prevention, so the pile you place next year is smaller than the one you placed this year, on purpose.

The pattern behind all seven

Every one of these questions is really the same question: will I be able to verify this, or will I have to take it on faith?

Good recovery operations are built to be verified. The pricing is structural, the declines come with reasons, the work leaves a log, the humans are in the loop at the moments that matter, the data handling is written down, the statement is an accounting document, and the learning flows back to you.

We built Prexisio to answer all seven this way, and we would rather you ask them than not. A practice that asks hard questions of its vendors is exactly the kind of practice whose claims we want to work.