PROVIDERS
You care for your patients.
We care for your practice.
HealthWorks plugs into your existing systems to support complex claims above and beyond traditional billing.
The first-and-only platform that identifies all types of complex claims
- Out-of-Network Billing (IDR)
- Motor Vehicle Accident (MVA)
- Patient Accounts Receivable
- Medical Coding & Auditing
- Contract Compliance
The No Surprises Act gives you the right to dispute out-of-network claims. In such a complex process, most providers don't have the bandwidth to do it at scale.
Certain providers almost always have qualifying claims:
- Emergency medicine groups and freestanding ERs
- Anesthesiology groups
- Radiology groups
- Air ambulance and ground transport operators
- General surgeons, orthopedic surgeons, and other OR-based specialists
- Any specialist who sees patients in an ER setting — even occasionally
- Hospitals and Hospital systems
HealthWorks identifies every qualifying state and federal out-of-network claim in your data, tracks it through the 30-day filing window, and builds the documentation needed to support a complete and accurate dispute.
Every month without a filed dispute is a month you can't recover.
Auto accident patients are already in your system. The liable third party — not your patient's health insurance — owes you for that care. Most practices never make that distinction.
Certain provider types have the highest MVA exposure:
- Emergency departments and trauma centers
- Freestanding ERs and micro-hospitals
- Anesthesiology and surgical groups
- Orthopedic and physical therapy practices
- Ambulance and air medical operators
- Any provider in a no-fault or PIP state
- Hospitals and Hospital systems
HealthWorks identifies accident-related claims in your existing data, determines the liable party, and pursues recovery at the rate you're actually owed — often full billed charges instead of a contracted rate.
Every claim billed to patient insurance is revenue left on the table.
As patient responsibility grows, the gap between what gets billed and what gets collected keeps widening. It's not that patients won't pay — it's that most billing experiences make paying harder than it needs to be.
Our platform delivers results across every practice type:
- Hospitals and health systems
- Freestanding ERs and ambulatory surgery centers
- Multi-specialty and single-specialty groups
- Any provider generating patient statements at volume
- Hospitals and Hospital systems
We are merchant services agnostic, with no accounts to create nor apps to download as well as a 99% client retention rate. HealthWorks runs your patient billing communication with personalized outreach that drives payment, reduces inbound calls, and protects the patient relationship at the same time.
You could be collecting 30% more in 30 days or less.
Denials don't start at adjudication. They start with documentation gaps, coding errors, and payer misalignment that gets built into a claim before it's ever submitted.
Coding accuracy is critical for every provider type:
- Emergency medicine and hospital-based groups
- Ambulatory surgery centers
- Anesthesiology and radiology groups
- Multi-specialty practices
- Any organization with in-house or outsourced coding
- Hospitals and Hospital systems
HealthWorks ensures every encounter is coded completely and accurately — reducing denials at the source, supporting compliance, and making sure every claim reflects the full value of the care delivered.
Get it right the first time and there's nothing left to dispute.
Every contract your practice has negotiated represents a precise payment commitment. But between payer system limitations, coding complexity, and claim volume, what gets paid and what was agreed to often aren't the same thing.
We make sure every claim is paid according to what your contract actually says.
- Powered by Sleuth®️ — our proprietary contract compliance platform
- Pre-pay and post-pay claim analysis
- Contract term validation against actual payment received
- Underpayment and bundling error identification
- No disruption to your existing billing workflow
- Hospitals and Hospital systems
When payer payment logic doesn't match your contract terms, the difference comes directly out of your revenue. Sleuth®️ closes that gap — systematically, at scale, and before it compounds.
One review can show exactly where your contracts aren't aligned to your revenue.
FAST START ASSESSMENT
Most of our customers are surprised by what a quick scan of their data reveals.
Our initial assessment can identify your recovery opportunity across every qualifying service line.
Common Questions
The questions providers ask us most — answered plainly.
Do I have to replace my existing billing system to work with HealthWorks?
No. HealthWorks plugs into your existing workflow using the standard claims and billing records you already generate — the same ones your clearinghouse processes today. There's nothing new to install, no systems to replace, and no retraining your billing team.
How quickly can we get started?
We can often provide an initial analysis in less than 24 hours of receiving your data. Complex claims typically shows measurable impact within the first 30 to 60 days. Auto accident recovery shows early pipeline results quickly, though full liability recovery on individual cases can take longer depending on how cases resolve. IDR arbitration runs on a 60- to 90-day cycle from filing to resolution, but you'll see claims moving into the pipeline as soon as we begin filing.
How do I know if my practice qualifies for IDR?
If your practice includes anesthesiology, radiology, emergency medicine, or air ambulance, you are explicitly named under the No Surprises Act and almost certainly have qualifying claims. If you have specialists who see patients in an ER setting — even occasionally — you may also qualify. One conversation with our team is usually enough to determine whether and how much opportunity exists in your data.
What states qualify for auto accident recovery?
Currently, we focus on states that require or encourage no-fault and personal injury protection, including Arkansas, Delaware, Florida, Hawaii, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Oregon, Pennsylvania, Texas, Utah, and Washington.
How is Patient AR different from a collections agency?
HealthWorks is very different. A collections agency pursues debt — often aggressively, and often at the cost of the patient relationship. Our platform sends personalized billing communication designed to make paying easy for the patient. The result is more collected, fewer inbound calls, and a billing experience patients don't resent.
What does HealthWorks charge?
Our fee structure varies by service and is typically tied to performance — meaning we recover revenue first, and our fee reflects a portion of what's recovered. There are no large upfront costs, and there are no charges or fees if can’t recover on your behalf.
How do you work with Payers?
Our leadership team has spent 30 years working inside health plans — understanding how they think, how they build contracts, and how they make payment decisions. This is the resaon we can be so effective for providers. When we identify an IDR opportunity, build an auto accident claim, or review an out-of-network payment, we know exactly what the payer is looking for. That insight and experience is what makes the difference between a prolonged dispute and a quick recovery.
How do you handle data security and compliance?
We operate to the same security and compliance standards your own organization is held to. In addition to HiTrust compliant, HealthWorks is fully HIPAA-compliant and executes a Business Associate Agreement with every client engagement — your data is protected health information and is treated accordingly. We are PCI DSS-compliant (Payment Card Industry Data Security Standard) for all payment-related data handling, and we maintain SOC 2 compliance — an independently audited framework that verifies our security controls, confidentiality practices, and system reliability are consistently upheld, not just designed on paper. For payer organizations specifically, SOC 2 Type 2 compliance means our controls have been tested over time, not just at a single point in audit. We are also TCPA-compliant (Telephone Consumer Protection Act) for any outbound communication workflows.
Making healthcare work better.