How a Freestanding ER Recovered $2.3M in Underpaid Claims
Turning payer disputes into predictable revenue
Regional ER Network
Regional ER Network
About
A network of freestanding emergency rooms providing 24/7 emergency care across Texas, serving over 50,000 patients annually.
Industry
Emergency Medicine
Company size
75-100 employees
Headquarters
Houston, TX
Founded
2018
Annual Claims
$12M+ billed annually
Key Features Used
Challenge
The ER network was leaving millions on the table. As an out-of-network provider, they faced systematic underpayment from major payers. Their billing team spent countless hours on appeals with a 12% success rate, and high-value claims sat unresolved for 12-18 months.
Solution
Deploy Clearest to analyze all historical claims, identify IDR-eligible disputes, and file strategically using verified peer benchmark data. Automated case selection focused on high-value opportunities with strong win probability.
Illustrative Results
$2.3M recovered
Total revenue recovered in first 12 months
94% win rate
On IDR disputes filed through Clearest
47 days
Average time from filing to payment
340+ hours saved
Billing team time redirected to patient care
The challenge of out-of-network emergency care
Freestanding emergency rooms operate in a unique position in healthcare. They provide critical, life-saving care 24/7, but as out-of-network providers, they often face significant payment challenges from insurance companies.
The ER network had grown to six locations across the Houston metro area, treating everything from heart attacks to broken bones. But their revenue cycle was broken.
Claims that should have been paid at reasonable rates were being systematically reduced to a fraction of billed charges. The billing team was overwhelmed, and the appeals process felt like shouting into the void.
Illustrative perspective
We were spending more time fighting insurance companies than focusing on patient care. Something had to change.
Finding the right claims to dispute
The No Surprises Act created an opportunity, but the network needed a strategic approach. Not every underpaid claim is worth disputing. The key is identifying cases where the evidence strongly supports a higher payment.
Clearest analyzed 18 months of historical claims data and identified 847 claims totaling $4.2M in potential recovery. But rather than filing everything, the platform scored each case based on win probability, expected recovery, and strategic value.
The result was a focused portfolio of 312 high-confidence disputes. Each case was built with verified peer benchmark data showing what similar facilities actually receive for the same services.
Building bulletproof dispute packets
Every IDR case filed through Clearest included comprehensive documentation: the qualifying payment amount, peer benchmark evidence from over 1.8M adjudicated claims, geographic and specialty-specific comparisons, and a clear narrative connecting the evidence.
The billing team no longer spent hours compiling documentation. Cases were prepared automatically, reviewed by compliance specialists, and filed within the 30-day window.
Illustrative perspective
The first time we saw a dispute packet from Clearest, we understood why we had been losing. We never had this level of evidence before.
Results that transformed the business
Within the first quarter, the network saw 67 disputes resolved in their favor, recovering $487,000 that had been written off as uncollectible. By month six, the pipeline was delivering consistent monthly recoveries.
More importantly, the billing team was freed from the appeals grind. Those 340 hours went back to eligibility verification, patient communication, and process improvement.
The predictable revenue stream also enabled the network to plan expansion to two new locations, knowing their existing claims were being maximized.
Illustrative perspective
Clearest turned our revenue cycle from a constant headache into a competitive advantage. We now recover what we deserve.
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