About American Family Care
American Family Care (AFC) is a prominent provider of urgent care and primary healthcare services throughout the State of Minnesota. It is renowned for its patient-first approach and dedication to quality care. AFC serves thousands of patients annually and focuses on delivering quality care. However, despite its operational excellence, the complexities of insurance billing and reimbursement can pose challenges, especially with Medicaid and private payers.
A Large Denial with No Clear Reason
AFC faced a significant medical billing challenge when Medicaid paid only 50% of a $100,000 claim for several patient procedures and denied the remainder. The provider was left without clear information about why the remaining $50,000 was rejected.
Adding to the confusion, initial information suggested that Blue Cross Blue Shield might be the responsible payer. This uncertainty created delays and left AFC unable to take the next step for resolution, risking a substantial revenue loss.
We Carried Out A Strategic Claims Investigation
AFC reached out to Liberty Liens, specialists in complex AR (accounts receivable) follow-up and claims resolution. Our team’s mission was to uncover the real reason for the denial and secure the right course of action to recover the outstanding amount or advise the client correctly.
At first glance, Liberty Liens also suspected that Blue Cross Blue Shield might be responsible. However, our experienced claims analysts didn’t stop at surface-level information. By performing a line-by-line review of EOBs (Explanation of Benefits), payer communications, and patient eligibility records, we identified a different root cause.
How Liberty Liens Got to the Root of the Issue
When the case was brought to Liberty Liens, our team followed a structured and evidence-based process to uncover what went wrong. Each step was handled with precision and open communication, ensuring both accuracy and accountability.
At Last, We Received Clear Answers & Informed Action
Within weeks, AFC gained a definitive understanding of the denied claims. Although the $50,000 could not be recovered from Medicaid or Blue Cross Blue Shield, Liberty Liens provided the provider with a clear plan to pursue the patient-responsible portion, directly avoiding further wasted time on incorrect payer follow-ups.
This allowed AFC to:
- Save weeks of internal staff time on incorrect claim resubmissions.
- Preserve staff resources for other revenue cycle priorities.
- Gain a clear compliance-friendly path to recover outstanding balances.
What Key Takeaways & Lessons to Learn Did We Get for Providers
- Don’t Stop at First Assumptions
The first information you get from a payer isn’t always the full story. Sometimes a claim looks denied when it’s actually just missing small details or stuck in system delays. Taking time to review eligibility and analyze each claim carefully helps uncover the real issue and recover payments that might otherwise be missed.
- Specialized Expertise Pays Off
Dealing with complex billing and payer rules can take up a lot of time and energy. That’s where working with an experienced AR follow-up company like Liberty Liens makes a difference. Our team knows how to handle claim denials, communicate with payers, and resolve issues efficiently. With the right expertise, providers can save time and protect their hard-earned revenue.
- Transparency Matters
Good communication builds trust. At Liberty Liens, we make sure our clients always know what’s happening with their claims. We share clear explanations, regular updates, and simple reports so providers can make quick, informed financial decisions with confidence.
Liberty Liens Confidently Guides Providers Toward Guaranteed Recovery
Billing denials don’t have to remain mysteries. Liberty Liens helps providers like American Family Care resolve complex payer issues with precision and transparency.
If your practice is facing unresolved claims or confusing denials, contact Liberty Liens today to see how we can help you recover lost revenue and regain control of your billing process.
