Comprehensive International Claims Management Services
From rapid benefits verification to final payment recovery, Riviera RCM delivers specialized revenue cycle management services designed exclusively for Caribbean and Latin American healthcare providers treating International patients.
Our Core Services
Expert solutions tailored to the unique challenges of international medical billing. Each service is backed by over 50 years of combined experience and a proven track record of exceptional results.
Rapid Benefits Verification
With round-the-clock availability, our industry-leading service delivers benefits verification within two hours, ensuring you have clear, accurate information about insurance coverage, benefits and patient responsibility prior to care.
- Two-hour response time
- Available 24 hours a day, 365 days per year, including weekends and holidays
- Policy reimbursement expectations
- Patient deposit reccomendations
- Prior-Authorization support
- Guarantee of Payment (GOP) acquisition
Prompt Claims Submission
Accurate, timely claim submissions by international billing specialists who understand both payer requirements and international healthcare documentation standards.
- Specialized international billing team
- Payer-specific claim formatting
- Complete documentation review
- Currency conversion management
- Timely claim submission
Persistent Payment Pursuit
Strategic, coordinated communication with insurance companies ensures claims move through the payment process efficiently. Our team engages multiple departments to drive resolution.
- Multi-department payer engagement
- Systematic escalation protocols
- Detailed claim tracking and reporting
- Regular status updates to providers
- Proactive denial prevention
Effective Appeals Management
When claims are denied, our experienced team crafts compelling appeals supported by comprehensive documentation and medical necessity justification to overturn denials and secure payment.
- Denial analysis and appeal strategy
- Clinical documentation review
- Medical necessity justification
- Multi-level appeal coordination
- Peer-to-peer review facilitation
- External review management
Legal Escalation Support
When standard collection efforts are exhausted, our legal department issues formal demand letters to insurance companies, leveraging legal grounds to prompt payment resolution and position your facility for further legal action if necessary.
- Legal review of unpaid claims
- Formal demand letter issuance
- Bad faith insurance documentation
- Pre-litigation case preparation
- Attorney coordination when needed
- Settlement negotiation support
Patient Advocacy
We serve as the liaison between your facility, the patient, and their insurance company, resolving complex billing issues and ensuring patient collaboration throughout the claims process.
- Insurance benefits explanation
- Balance resolution guidance
- Coordination of Benefits assistance
- Medical Evacuation coordination
- Bilingual patient communication /li>
Our Proven Process
A systematic approach to international claims management, refined through decades of exclusive focus on recovering insurance payments for foreign healthcare providers.
Rapid Verification
Within 2 hours of patient referral, we verify insurance coverage, benefits, and patient responsibility. Our 24/7/365 service ensures you have financial clarity before providing care.
Documentation Collection
We work with your admissions team to collect necessary patient information, secure required consents and waivers, and ensure all compliance documentation is properly completed.
Expert Claim Preparation
Our international billing specialists review medical records, assign proper coding, format claims to payer specifications, and prepare comprehensive documentation packages.
Timely Submission
Claims are submitted to insurance companies with all required supporting documentation, meeting payer-specific requirements and submission deadlines.
Strategic Follow-Up
We maintain persistent communication with insurance companies, coordinating across multiple departments, escalating as needed, and documenting all interactions to drive claims to payment.
Appeals & Escalation
When claims are denied, we craft detailed appeals with supporting documentation and medical justification. If needed, we escalate to senior management or issue legal demand letters.
Payment Recovery
We secure maximum reimbursement, reconcile accounts, and provide detailed reporting. Your revenue is recovered and your accounts are closed.
Ongoing Reporting
Regular reports keep you informed of claim status, open and closed inventory, and recovery metrics. Consistent communication ensures you always know where your revenue stands.
Why Healthcare Providers Choose Riviera RCM
Our specialized expertise and proven results deliver tangible benefits that directly impact your facility's financial performance and operational efficiency.
Fiscal Control
2-hour coverage verification provides financial clarity before care delivery, significantly reducing the risk of uncompensated care when treating international patients abroad.
Maximized Revenue Recovery
Our persistent follow-up, effective appeals process, and legal support when necessary result in exceptional account recovery rates that consistently exceed industry standards.
Ease of Use
Our paperless, automated referral platform eliminates time-consuming tasks, allowing staff to focus on patient care and core operations.
24/7/365 Availability
Round-the-clock coverage verification and support means we're ready when your patients need care, regardless of time zone or day of the week.
Our Services: Drive Stronger Financial Results
Partner with the specialists in global healthcare receivables. Our proven expertise, unrivaled availability, and incomparable pricing unlocks greater value from international patient care.