Pacific Recoveries
Revenue Delivery Solutions

Managed Care Audit

The complexity of managed-care contracts has created extensive administrative problems for healthcare providers. The reasons for payment errors and billing problems are different from facility to facility, but the results are always the same—lost revenue.
Pacific Recoveries offers a complete solution. We help healthcare providers analyze, identify, re-bill and recover underpayments. Work is completed retroactively on closed, or “zero balance” accounts, and will not interfere with your daily operations. Our service is offered risk free, on a contingency basis, and at no upfront cost.

Get the best of both worlds:
Contingency Based Audit Recovery Services—Advanced Technology to Audit All Claims.

Client Accountability

Pacific Recoveries leads the industry in accountability to our clients. With the Optima system, our proprietary Web-based patient accounting system, data is easy to access, and extremely accurate. The system allows for a detailed accounting of our work to our clients, which allows them to report how the provision of our services delivers revenue and positively benefits the community.

Technology and Expertise

Pacific Recoveries’ proprietary Optima system effectively completes the analysis and recovery process, accurately calculating the expected reimbursement on every claim provided. The system also provides the infrastructure to effectively manage the entire process of underpayment recovery—from identification, to receipt of payment. And it serves as a repository of all underpayment history, identifying trends, and finding the sources of the errors.
Pacific Recoveries offers customized reporting that can be tailored to meet each client’s needs. Our experienced staff has expertise in managed-care payment compliance, contractual negotiations, billing, and collections.
Pacific Recoveries will provide you with a complete solution including:


  • Contingency-based payment compliance audit and recovery
  • A comprehensive analysis process aimed at identifying underpayments and recovering lost revenue
  • Re-billing of underpaid claims, and recovery of the appropriate payment adjustments
  • Increased financial returns from managed care—risk free
  • Securing of appropriate payment adjustments
  • Graphic analysis of your managed-care performance
  • Improvement of your managed-care payment review processes
  • Recommendations for future contract negotiations to increase potential revenue in specific areas
  • Customized reports, highlighting the sources of payment errors

Pacific Recoveries provides healthcare systems complete Revenue Cycle solutions in coordination with the Outreach Services companies, maximizing reimbursement for difficult account types.
From uncompensated-care management to managed-care claims audits, our services are geared to improve revenues, while supporting hospitals’ role as community service providers.
Please contact at (800) 544-9923 to learn more about our comprehensive suite of Revenue Cycle solutions.