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1,200+ payer rosters · 11% recovery · monthly cadence

Find coverage on self-pay accounts, monthly.

A meaningful share of accounts you classify as self-pay are not actually uninsured. They have Medicaid managed care under a different plan name, COBRA continuation the front office never asked about, a secondary commercial plan that activated since the visit, or a Medicare Advantage organization the registrar missed. The ASP-RCM discovery engine sweeps 1,200+ payer rosters every month, runs 270/271 confirmation on every hit, and reclassifies confirmed coverage into billable AR with the audit trail attached.

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1,200+ payer rosters scanned monthly 270/271 confirmation on every hit NPPES in-network match per claim

The discovery workflow

Where every 100 self-pay accounts end up after a sweep.

A discovery sweep is not a single query. It is a deterministic, multi-stage pipeline. Stage one runs identity lookup (name plus DOB plus, where consented, last four of SSN) against 1,200+ payer rosters. Stage two cross-references rendering provider in NPPES against the matched payer’s network roster. Stage three runs a 270/271 round-trip to confirm coverage was active on the date of service. Stage four pushes confirmed coverage into the claim record and triggers retroactive billing if the timely-filing window is still open.

The triage to the right shows where 100 self-pay accounts actually land. 11 confirm to billable AR; 14 confirm to coverage that is out-of-network or past timely filing (documented for review); 18 confirm prior coverage but inactive on the date of service; 57 confirm true self-pay with no discoverable coverage.

Per 100 self-pay accounts swept · active book · last 90 days

Confirmed billable AR270/271 confirms active coverage on DOS, in-network

Confirmed coverage, out-of-network or past TFLDocumented for client director review and write-off decision

Prior coverage, inactive on DOSHistorical record, no recovery, drives front-office training

True self-pay, no discoverable coverageRoutes to sliding-fee scale or patient billing

Discovery is a workflow, not a single query · monthly cadence

The capabilities

Six capabilities. From sweep to billable AR.

Each capability runs in production today. Discovery is monthly cadence on every self-pay account under 365 days from date of service. Every confirmed match carries the 270/271 trace, the NPPES network match, and the audit trail.

01 · Monthly sweep

Cross-payer, every cycle.

Every self-pay account under 365 days from date of service runs through the monthly discovery cycle automatically. Cadence is monthly because payer rosters refresh monthly, eligibility activates monthly, and the cost of running the sweep is near zero compared to the recovery value of one confirmed match.

02 · Roster match

NPPES plus payer roster.

Patient identity matched against 1,200+ payer eligibility rosters. Rendering provider cross-referenced against NPPES to verify network status with the matched payer on the date of service. In-network match flips the claim to standard contracted rate; out-of-network match flips to the correct OON workflow.

03 · 270/271 confirmation

X12 round-trip, every hit.

Every roster match runs through a real-time 270 inquiry against the payer’s eligibility system. The 271 response confirms active coverage on date of service, benefit category, cost-sharing, and prior-auth requirement. Without the 271, a roster hit is a hint; with the 271, it is a billable account.

04 · AR reclassification

Push to billable AR.

Confirmed discoveries push payer, member ID, group number, and effective dates into the claim record in the EHR or billing system. The account reclassifies from self-pay to billable AR and routes through normal billing: charge entry, submission, and AR follow-up against the new payer.

05 · Retroactive optimization

Timely filing window first.

Discoveries are sorted by remaining timely filing window per payer per claim. Shortest-window claims work first. Discoveries beyond the window get a documented write-off recommendation with the dollar value and the reason. Long-window Medicaid discoveries hold for batched submission.

06 · Audit trail

Logged per discovery.

Every discovery logs the roster matched, the 270/271 transaction trace, the confirmed coverage details, the operator who posted the reclassification, and the resulting claim ID. Exportable for compliance, payer audit response, and FQHC sliding-fee scale documentation.

How the sweep runs

Four steps. SSN/DOB to billable AR.

From the moment a self-pay account enters the discovery queue to the moment the confirmed coverage posts back to the EHR, here is what the engine and our coordinators run together.

Step 01

SSN/DOB lookup.

Patient identity (name plus DOB plus, where consented, last four of SSN) queries the 1,200+ payer roster set. Identity-only matching avoids HIPAA exposure outside the discovery envelope. Roster matches return as candidate coverage hints.

Step 02

Cross-payer match.

Each candidate match cross-references the rendering provider on the original claim against NPPES and against the payer’s network roster. In-network vs out-of-network status on DOS resolves before confirmation. Multiple-payer matches sort by primary, secondary, tertiary.

Step 03

270/271 confirmation.

X12 270 eligibility inquiry against the payer’s real-time system. 271 response confirms active coverage on DOS, benefit category, cost-sharing, and prior-auth requirement. Confirmation receipts attach to the claim record for compliance review.

Step 04

Reclassify to AR.

Confirmed discoveries push to the EHR with payer, member ID, group, effective dates. Claim routes through normal billing. Audit trail closes with operator ID, timestamp, and resulting claim ID. Sweep cycle archives for the next monthly run.

What clients see

Measured outcomes from monthly discovery.

Across the active book. Anonymized; individual results depend on payer mix, demographic profile, and the recency of self-pay assignment.

11%

Self-pay recovery rate

Of self-pay accounts swept monthly, 11 percent confirm to active billable coverage. Range is 8 to 14 percent depending on payer mix. Highest yield comes from accounts under 90 days self-pay where front-office capture failed but coverage was always there.

1.2K+

Payer rosters scanned

Commercial, Medicaid managed care by state, Medicare Advantage, employer self-funded TPAs, COBRA continuation, dual-eligible, exchange marketplace, Tricare, VA secondary, workers’ comp. Coverage hides in the long tail; the long tail is what we scan.

100%

270/271 confirmation

Every roster match runs a 270/271 confirmation before AR reclassification. No claim flips to billable AR on a roster hint alone. The 271 receipt attaches to the claim for compliance, payer audit, and FQHC sliding-fee documentation.

Common questions

Frequently asked questions: Insurance Discovery.

What is insurance discovery actually doing?

Insurance discovery is a deterministic, repeatable cross-payer sweep on accounts classified as self-pay or uninsured. Using the patient's name, date of birth, and (where consented) last four of SSN, the engine queries 1,200+ payer eligibility rosters in monthly cycles. When a coverage match returns, the engine runs a 270/271 round-trip to confirm active eligibility on the date of service. Confirmed matches reclassify from self-pay to billable AR with the payer, member ID, and effective dates loaded into the claim record.

Why 1,200+ payer rosters?

Coverage hides in places most providers do not scan. Commercial carriers, Medicaid managed care plans by state, Medicare Advantage organizations, employer self-funded plans administered by national TPAs, COBRA continuations, dual-eligible programs, exchange-marketplace plans, Tricare, VA secondary, workers' comp carriers. Scanning only the top 50 payers misses the long tail. The 1,200+ roster set covers more than 98 percent of US covered lives.

What is the 11% recovery number?

On the active book, monthly discovery sweeps on self-pay AR identify confirmed active coverage on approximately 11 percent of accounts. Recovery range across clients is 8 to 14 percent depending on payer mix, demographic profile, and how recently self-pay status was assigned. Highest yield comes from accounts under 90 days self-pay where the patient may have had coverage at date of service but the front-office capture failed.

How does the NPPES plus payer-roster match work?

NPPES is the federal provider registry and is what payers use to match the rendering provider on roster entries. The discovery engine matches patient identity against payer rosters first, then cross-references the rendering provider on the original claim against the same payer's network roster via NPPES. If the patient has coverage and the provider is in-network on the date of service, the account flips to billable AR with the correct in-network rate. If the patient has coverage but the provider was out-of-network, the account flips with the correct out-of-network treatment.

What is the 270/271 confirmation step?

X12 270 is the standard eligibility inquiry transaction; 271 is the response. When a payer roster lookup returns a possible coverage match, the engine submits a real-time 270 against the payer's eligibility system. The 271 response confirms whether coverage was active on the date of service, what the benefit category was (medical, behavioral, BHRS), what cost-sharing applies (copay, coinsurance, deductible remaining), and whether prior authorization was required. Without the 271, a roster hit is just a hint; with the 271, it is a billable account.

How does AR reclassification work?

When a 271 confirms active coverage on the date of service, the engine pushes the discovered payer, member ID, group number, and effective dates into the claim record in your EHR or billing system. The account reclassifies from self-pay to billable AR. The claim is then routed through normal billing: charge entry, claim submission, and AR follow-up. The discovery audit trail stays attached to the claim so the source of the coverage is documented for the payer's records and for compliance review.

What about retroactive billing windows?

Most payers honor a timely filing window of 90 to 365 days from date of service. Some Medicaid plans honor longer windows for retroactive coverage determinations. The discovery engine flags every confirmed discovery with the remaining timely filing window per payer per claim. The retroactive billing optimizer sorts the discoveries by remaining window so the specialist works the shortest-window claims first. Past-window claims get a documented write-off recommendation with the dollar value.

Is there an audit trail per discovery?

Every discovery is logged: the patient identifier, the roster matched, the date of the match, the 270/271 transaction trace, the confirmed coverage details, the operator who reviewed and posted the reclassification, and the resulting claim ID. The audit is exportable for compliance review, payer audit response, and FQHC sliding-fee scale documentation where the patient's discovered coverage changes the FPL grant calculation.

Pairs with

Compounds with eligibility and credentialing.

Discovery is one of three coverage signals. Eligibility verification handles the front-door check. CredPro v6 handles the provider-side enrollment. Discovery handles the back-end recovery on accounts where the first two signals missed.

CredPro v6

Provider enrollment.

HIPAA-hardened credentialing with PHI-at-rest encryption and per-payer enrollment tracking. NPPES sync feeds the discovery engine’s network-match step so in-network vs out-of-network resolves cleanly.

AR Workflow Engine

Triaged recovery.

Confirmed discoveries flow into the AR engine and triage by recoverable dollars. Predicted call outcome and senior-specialist routing apply to discovered AR the same way they apply to original billable AR.

SLA & uptime

Discovery SLA.

Monthly sweep cadence written into the SLA. 99.9 percent uptime on the discovery engine. Backed by quarterly DR drills, daily encrypted backups, and a published status page.

Send your self-pay AR. We send back the discovery map.

A free self-pay discovery sweep. Drop your last 90 days of self-pay AR. We return a four-page audit: confirmed coverage discoveries with dollar value, in-network vs out-of-network split, timely-filing windows remaining, and a 90-day monthly cadence plan. A senior partner on the call.

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