Eligibility Advantage

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Eligibility Advantage Overview

Performant healthcare solutions offers unique, high-return offerings that resolve Eligibility (coordination of benefits) issues for government-funded health plans through our MSP Advantage and TPL Advantage suite of solutions, which include MSP premium accuracy and TPL reclamation services.

Eligibility-based services, which may also be referred to as coordination-of-benefits, involve identifying and recovering payments in situations where our client should not be the primary payer of healthcare claims because a member has other forms of insurance coverage. We are paid contingency fees by our clients based on a percentage of the dollar amount of improper claims recovered as a result of our efforts. The revenues we recognize are net of our estimate of claims that we believe will be overturned by appeal or disputed following payment by the provider.

For eligibility or COB contracts, insurance companies or other responsible parties may dispute the Company’s findings regarding our clients not being the primary payer of healthcare claims.