Services | Nsure

Before the claim exists · 7 modules

Pre-billing

Runs at registration and before submission, so the first pass goes out right.

Insurance Verification

Real-time eligibility across 1,000+ payers at registration.

You getFewer eligibility denials

When it runs: At registration, before the visit
What it does: Real-time eligibility across 1,000+ payers: active coverage, plan, copay, deductible status, and whether a referral or authorization is needed.
What you get: Fewer eligibility denials. Your first pass goes out with coverage confirmed.
Who does what: Automatic: Checks eligibility on every registration and flags gaps. No people needed, on either plan.

Demographic Verifier

Name, DOB, address, and phone corrected against credit-bureau data.

You getFewer denials, 60% less returned mail

When it runs: At registration
What it does: Name, date of birth, SSN, address, and phone checked and corrected against credit-bureau data before a typo becomes a denial or a returned statement.
What you get: Fewer demographic denials and far less returned mail. One client cut returned mail by 60%.
Who does what: Automatic: Checks and corrects identity and address on every registration. No people needed, on either plan.

Insurance Discovery

Finds billable coverage for self-pay and lapsed patients.

You get20–40% of self-pay comes back covered

When it runs: At registration, and again on every self-pay balance
What it does: Finds active, billable coverage for patients who registered as self-pay or whose coverage lapsed: commercial, Medicare, Medicaid, and VA. Then bills the right payer.
What you get: Self-pay accounts that turn into paid claims. Clients see 20% to 40% of self-pay volume come back with coverage.
Who does what: Automatic: Finds billable coverage on self-pay and lapsed accounts. Follow-through: Billing the found payer: your team on a license, Nsure on the managed service.

Prior Authorization

Checks whether auth is required, then submits and tracks it.

You getNo-auth denials stop before they start

When it runs: Before the service is delivered
What it does: Determines whether a payer requires authorization, submits it, tracks it, and ties the approval to the claim from one portal.
What you get: No-auth denials stop before they start. Staff stop living on payer portals.
Who does what: Automatic: Determines whether authorization is required, submits, and tracks it. No people needed, on either plan.

Coding & Charge Review

Compares the documentation to the codes on the claim.

You getRevenue earned but never billed

When it runs: Before submission, and retrospectively inside the timely-filing window
What it does: Documentation compared to the codes on the claim: levels the notes support, procedures performed but never charged, modifiers that change the payment. Corrected and refiled where the window allows.
What you get: Revenue earned but never billed. Fewer downcoded visits.
Who does what: Automatic: Flags levels the documentation supports, unbilled procedures, and missing modifiers. Follow-through: Correcting and refiling: your team on a license, Nsure on the managed service.

TPL Discovery & Scrubbing

Finds the auto, work comp, or liability carrier that owes first.

You getInjury claims paid at the right rate

When it runs: Before submission
What it does: Identifies auto, workers’ comp, and liability carriers that owe the encounter first, and reroutes the claim before the health plan pays a fraction and the deadline passes.
What you get: Injury claims paid by the carrier that owes them, often at several times the health-plan rate.
Who does what: Automatic: Identifies the auto, work comp, or liability carrier that owes the encounter. Follow-through: Rerouting the claim: your team on a license, Nsure on the managed service.

Deductible Hold

Holds claims headed for an unmet deductible, releases them in time.

You getPayer payments, not patient balances

When it runs: Before submission, early in the plan year
What it does: Holds claims likely to land on an unmet deductible, watches for the deductible to be met elsewhere, and releases the claim to file before the timely-filing limit.
What you get: Payer payments instead of patient balances you’d have chased.
Who does what: Automatic: Holds and releases claims on deductible timing. No people needed, on either plan.

Submission stays yours. Your team submits through the clearinghouse you already use. Nsure works before and after that step.

When the payer answers · 3 modules

Post-billing

Every remit read against your contract. Every denial worked inside the window.

Underpayment & Contract Variance

Audits every remit against your contracted rate.

You getShort payments found and pursued

When it runs: On every remit
What it does: Every payment audited against your contracted rate and fee schedule. Anything paid short is identified by line, totaled by payer, and pursued with the contract as evidence.
What you get: Dollars payers kept that no one had time to check. A payer-by-payer record for your next negotiation.
Who does what: Automatic: Audits every remit against the contract and totals short payments by payer. Follow-through: Pursuing the payer: your team on a license, Nsure specialists on the managed service.

AI Denial Management

Groups every denial by root cause, ranked by dollars and deadline.

You getFewer repeat denials next quarter

When it runs: On every denial
What it does: Every denied line grouped by root cause and ranked by dollars and days left in the appeal window. The root cause becomes a rule, so the same denial stops happening upstream.
What you get: Denials worked in priority order, and fewer of them next quarter.
Who does what: Automatic: Groups every denial by root cause and ranks the worklist. Follow-through: Working the list: your team on a license, Nsure specialists on the managed service.

Appeals

AI-drafted appeal packets with documentation and contract attached.

You getAppeals out in days, not weeks

When it runs: Inside the appeal window
What it does: The models draft the appeal packet with the documentation, payer policy, and contract language attached. Certified specialists review, file, and follow up until it pays or the payer gives a final answer.
What you get: Appeals that go out in days, not weeks, with a higher overturn rate.
Who does what: Automatic: Drafts the appeal packet with documentation, policy, and contract attached. Follow-through: Filing and following up until it pays: your team on a license, Nsure specialists on the managed service.

What’s left after the payer · 4 modules

Patient

Coverage first, then a fair conversation under your practice’s name.

Retroactive Medicaid

Watches for Medicaid approved after the date of service.

You getPaid claims from would-be write-offs

When it runs: Continuously, on self-pay and unpaid balances
What it does: Watches Medicaid enrollment for coverage approved after the date of service, then rebills the encounter to Medicaid automatically.
What you get: Paid claims from balances that would have been written off.
Who does what: Automatic: Watches Medicaid enrollment and rebills approved encounters. No people needed, on either plan.

Self-Pay Analyzer

Scores every self-pay balance for ability to pay and assistance.

You getOutreach only where it works

When it runs: Before any patient outreach
What it does: Every self-pay balance scored for ability to pay, likelihood to pay, and eligibility for Medicaid or financial assistance, so your team knows who to call, who to help, and who to stop billing.
What you get: Outreach where it works, charity care where it’s owed, and no money spent chasing balances that will never pay.
Who does what: Automatic: Scores every self-pay balance for ability to pay and assistance eligibility. No people needed, on either plan.

Patient A/R Recovery

Statements, payment-link texts, and AI calls in your practice’s name.

You getPatient balances collected sooner

When it runs: After the payer has paid its share
What it does: Statements, texts with a payment link, and calls from an AI assistant that sounds like your office, all under your practice’s name and financial policy. Payments go to your merchant account.
What you get: Patient balances collected sooner, with fewer calls your staff has to make and no collection-agency feel.
Who does what: Automatic: Statements, texts with a payment link, and AI voice calls in your name. Follow-through: Exceptions and payment plans that need a person: Nsure on the managed service.

Aged A/R Cleanup

Works everything over 90 days to resolution.

You getAn A/R that reflects what you’ll collect

When it runs: Everything over 90 days
What it does: Insurance and patient balances over 90 days worked to resolution: rebilled, appealed, routed to the right payer, or closed with a reason, while your team stays on current claims.
What you get: An A/R that reflects what you’ll actually collect, and a team that isn’t buried in old claims.
Who does what: Automatic: Surfaces and prioritizes everything over 90 days. Follow-through: Working old balances to resolution is people work: Nsure specialists on the managed service.

Not sure which modules you need?

Ten minutes on the questionnaire. We show you where practices like yours leak, which modules do the work, and the range we typically recover.

Get My Free Recovery AnalysisOr call (888) 983-2432

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