NewBecker's 2026 Top RCM · Inc. 5000 · Dallas 100
A behavioral health platform grew collections by $2.4M / year with Plutus Health →
SOC 2 Type 2 · HIPAA · BHCOE · CASP
Plutus Health delivers end-to-end complex claims management services for Workers' Compensation (WC), Motor Vehicle Accident (MVA), Third-Party Liability (TPL), No Surprises Act (NSA), Independent Dispute Resolution (IDR), and other high-value reimbursement scenarios.
Get Your Free Complex Claims Assessment →Explore All 25 AI Agents →Our team manages the complete workers' compensation revenue cycle, including carrier identification, authorization verification, jurisdiction-specific billing, fee schedule compliance, documentation review, denial resolution, and reimbursement follow-up.
We coordinate medical billing for automobile accident claims by identifying responsible carriers, verifying policy information, managing liens where appropriate, and communicating with attorneys, adjusters, and insurance companies.
Our specialists investigate liability coverage, identify primary and secondary responsibility, resolve coordination-of-benefits issues, and pursue reimbursement from all available payment sources.
Plutus Health manages the complete No Surprises Act and Independent Dispute Resolution process, including eligibility review, Open Negotiation, IDR submission, supporting documentation, benchmark analysis, and arbitration management to improve reimbursement outcomes.
Our insurance discovery services identify commercial, Medicare, Medicaid, employer-sponsored, and secondary insurance coverage that may have been unavailable during initial registration. Recovering previously unidentified coverage improves reimbursement while reducing patient balances.
Complex claim denials require specialized investigation. Our denial management team reviews documentation, identifies payer-specific denial patterns, prepares appeal packages, supports arbitration, and follows claims through final reimbursement.
Insurance Discovery AI continuously searches commercial payers, government programs, employer plans, and historical eligibility databases to identify active primary, secondary, or tertiary coverage that traditional verification processes often miss.
OlympusAI analyzes claim characteristics, payer behavior, state regulations, liability indicators, coordination-of-benefits rules, and reimbursement history to classify each account and recommend the most effective resolution strategy before work begins.
Experienced complex claims specialists, reimbursement analysts, and regulatory experts validate findings, coordinate with payers, attorneys, adjusters, employers, and healthcare organizations, manage negotiations, and oversee every claim through successful payment while maintaining regulatory compliance.
Incoming complex claims are categorized according to reimbursement opportunity, claim complexity, payer type, liability involvement, and regulatory requirements. We provide immediate specialist attention to high-value accounts to reduce avoidable payment delays.
Dedicated teams coordinate communication across insurance carriers, employers, legal representatives, adjusters, providers, and patients while maintaining complete documentation required throughout the reimbursement lifecycle.
Every complex claim is monitored through negotiation, appeal, arbitration, payment verification, and final reimbursement. Performance reporting tracks recovery rates, turnaround times, payer trends, outstanding balances, and operational improvements.
Schedule a complimentary Complex Claims Assessment to identify hidden coverage opportunities, unresolved liability claims, reimbursement risks, NSA/IDR opportunities, and recovery potential across your complex claims portfolio.
