Medical Claims Recovery and Denial Solutions
Medical Claims Recovery and Denial Solutions is a contingency-based medical claims appeals and recovery firm serving nursing homes, hospitals, specialty practices, and workers' comp cases across all 50 states with a small expert team.
- Company typePrivate
- Founded2008
- HeadquartersPortland, United States
- Headcount1–10
- GTM typeB2B
- OfferingServices
What Medical Claims Recovery and Denial Solutions does
Medical Claims Recovery and Denial Solutions (MCR&DS) is a founder-owned LLC established in 2008 and headquartered in Cranford, New Jersey. The firm specializes in medical claims appeals and recovery services on a contingency basis, working denied or underpaid claims on behalf of healthcare providers. The company is led by founder Letty Carroll, a Registered Nurse (RN), Certified Care Manager, and trained ERISA Appeals specialist, and the team collectively brings 80+ years of combined experience in claims recovery.
The company serves a diverse base of healthcare clients across all 50 states, including skilled nursing facilities, rehabilitation centers, acute care hospitals, specialty medical practices (radiology, pain management, physical therapy, surgical), and workers' compensation cases. Named clients include Cayuga County Nursing Home, Park Manor Rehabilitation, Syracuse Home Association, Radiology Specialists Ltd, Braxton Health Care Center, Forest Manor Health Care Center, Liberty Mutual Insurance, and Horizon Casualty Services. The service model is explicitly manual and human-expertise-driven: MCR&DS does not operate a proprietary technology platform, and the value proposition rests on clinical credentials, ERISA appeals expertise, and recovery execution rather than software automation.
MCR&DS operates with a small team of 1–10 employees, generating revenue through contingency fees tied to successfully recovered claims. The go-to-market relies on direct relationships, customer referrals, and testimonial-driven demand within the post-acute and specialty provider community. There is no public funding history, no acquisition activity, and no disclosed revenue figures. The business model is asset-light, with no notable technology infrastructure beyond standard office productivity tools, positioning the firm as a specialized professional services boutique rather than a technology-enabled healthcare revenue cycle vendor.
Medical Claims Recovery and Denial Solutions firmographics
Firmographics- Name
- Medical Claims Recovery and Denial Solutions
- Legal name
- Medical Claims Recovery and Denial Solutions, LLC
- Website
- https://mcrds.com
- Company type
- Private
- Founded year
- 2008
- Operating status
- Operating
- Headcount range
- 1–10 employees
- Short description
- Medical Claims Recovery and Denial Solutions is a contingency-based medical claims appeals and recovery firm serving nursing homes, hospitals, specialty practices, and workers' comp cases across all 50 states with a small expert team.
- Ownership category
- akta.pro rank
Medical Claims Recovery and Denial Solutions industry classification
Industry- Product category
- Healthcare Revenue Cycle Management
- NAICS
- Collection Agencies (56144)
- SIC
- Services-Health Services (8000)
- akta.pro primary industry
- Denials Management & Appeals (HLACACAH)
- akta.pro secondary industries
- Medical Debt Collection & Revenue Cycle Bad-Debt Recovery (FSAKAJAM), Subrogation, Recovery & Coordination of Benefits (COB) Support (BPAAAFAG)
Keywords
Where Medical Claims Recovery and Denial Solutions is headquartered
LocationHeadquarters
- HQ city
- Portland
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Medical Claims Recovery and Denial Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Marketing or Sales
Revenue model
- Contingency-based Claims Recovery: MCR&DS operates exclusively on a contingency fee basis. The company charges no startup fees and only receives payment when unpaid or denied medical claims are successfully recovered and paid by insurance companies. This aligns the company's incentives directly with client outcomes and eliminates upfront financial risk for clients.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Outcome Based/ Performance | Monthly | Contingency-based pricing with no upfront costs |
Go-to-market motion1 record
Distribution channels1 record
Marketing channels3 records
Medical Claims Recovery and Denial Solutions product offering
Product offeringCore offering
Medical Claims Recovery and Denial Solutions recovers revenue for healthcare providers from denied or underpaid medical insurance claims. Services include denial root-cause analysis, appeals preparation and submission, payer negotiation, and ongoing denial trend reporting, delivered on a contingency-fee basis so the firm is paid only on dollars actually recovered. The target client base comprises nursing homes, hospitals, and physician practices struggling with payer denials.
Product overview
Medical Claims Recovery and Denial Solutions (MCR&DS) offers a unified service platform focused on medical claims appeals and follow-up for denied and unpaid claims. The company operates with three integrated service offerings: Appeals and Follow-Up Services (handling aging Account Receivables through timely filed appeals), Insurance Reimbursement Specialist Services (leveraging over 80 years of combined experience in claims management and billing/coding), and Specialty Medical Claims Services (customized solutions for various healthcare facilities including nursing homes, hospitals, surgical centers, and rehabilitation practices). All services are delivered on a contingency basis with no upfront cost to clients.
Differentiator
Problem solved
Functional benefit
Products and services
- Medical Claims Denial Recovery
Quantifiable outcome
- Denied or untimely claims can represent 20 to 40 percent of revenue over three years
- +2 more outcomes
Companies that use Medical Claims Recovery and Denial Solutions
Customer profileNamed customers8 records
Segments4 records
Ideal customer profiles1 record
Medical Claims Recovery and Denial Solutions technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Medical Claims Recovery and Denial Solutions partnerships and signals
Strategic signalScale indicators3 records
Recent moves5 records
Expansion highlights3 records
Medical Claims Recovery and Denial Solutions competitors and assessment
Company assessmentBroad incumbents
- R1 RCM: R1 RCM is one of the largest outsourced revenue cycle management providers to US health systems, offering denial management among other services. It overlaps with MCR&DS on the denial appeals and accounts receivable recovery stack at much larger scale and contractual scope.
- Experian Health: Experian Health provides claims management, denial/appeal automation, and payer connectivity used by hospitals and large provider groups. It overlaps with MCR&DS on claim denial recovery but operates at much greater scale and via technology platforms.
- Waystar: Waystar is a large healthcare payment and RCM software platform with denial management and claims processing modules. It competes for the same denial management budget that MCR&DS taps, but addresses it with end-to-end SaaS rather than outsourced appeals services.
Direct peers
- Zotec Partners: Zotec Partners provides billing, coding, denials, and RCM services to physician practices and radiology/specialty groups. Its specialty practice orientation and denial-appeals focus make it operationally comparable to MCR&DS's specialty claims recovery offerings.
- Aspirion: Aspirion is a denial-focused revenue cycle vendor that recovers underpaid, denied, and aged claims for hospitals and health systems on a contingency basis. Like MCR&DS, it specializes in complex denial appeals (clinical and technical), making it the closest comparable in business model and service scope.
- HealthCare Administrative Partners: HAP provides RCM, denial management, and accounts receivable recovery services tailored to hospital-based physician groups and specialty practices. Comparable to MCR&DS in targeting specialty providers and nursing facilities with denial recovery and appeals workflows on an outsourced basis.
- Coronis Health: Coronis Health offers end-to-end medical billing, RCM, and denial management services for hospitals, physician groups, and long-term care providers. Comparable long-term/specialty provider focus and contingency-friendly service lines overlap directly with MCR&DS.
- Aviacode (now part of Optum): Aviacode is a coder-driven medical coding and denial support vendor serving hospitals, physician groups, and surgical practices. Its specialty coding and appeals focus for complex procedure-heavy claims is operationally similar to MCR&DS's clinical-knowledge-led appeals model.
Emerging players
- PMMC (now Availity Essentials): PMMC, operating within the Availity ecosystem, focuses on patient access, eligibility, and denial prevention/management for hospital and provider clients. It targets the same denial-reduction value proposition as MCR&DS but through technology and analytics rather than outsourced appeals.
- AKASA: AKASA builds AI-driven RCM automation targeting denial management and appeals for hospitals and health systems. Same end customers and pain points as MCR&DS (denials, aging A/R) but with a technology-enabled, automation-led delivery model rather than human review.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat3 records
Key risks7 records
Key highlights7 records
Customer concentration
Medical Claims Recovery and Denial Solutions social profiles
Digital presenceMedical Claims Recovery and Denial Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
Medical Claims Recovery and Denial Solutions leadership team
Management profileNumber of profiles
Profiles1 record
Medical Claims Recovery and Denial Solutions funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Medical Claims Recovery and Denial Solutions M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Medical Claims Recovery and Denial Solutions
What does Medical Claims Recovery and Denial Solutions do?
Medical Claims Recovery and Denial Solutions recovers revenue for healthcare providers from denied or underpaid medical insurance claims. Services include denial root-cause analysis, appeals preparation and submission, payer negotiation, and ongoing denial trend reporting, delivered on a contingency-fee basis so the firm is paid only on dollars actually recovered. The target client base comprises nursing homes, hospitals, and physician practices struggling with payer denials.
Is Medical Claims Recovery and Denial Solutions a public or private company?
Medical Claims Recovery and Denial Solutions is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Medical Claims Recovery and Denial Solutions founded?
Medical Claims Recovery and Denial Solutions was founded in 2008. It employs 1 to 10 people.
Where is Medical Claims Recovery and Denial Solutions based?
Medical Claims Recovery and Denial Solutions is headquartered in Portland, United States, in the North America region.
How does Medical Claims Recovery and Denial Solutions make money?
One revenue line is on record: contingency-based Claims Recovery.
Who are Medical Claims Recovery and Denial Solutions's main competitors?
Broad incumbents on record are R1 RCM, Experian Health and Waystar. Direct peers are Zotec Partners, Aspirion, HealthCare Administrative Partners, Coronis Health and Aviacode (now part of Optum). Emerging players are PMMC (now Availity Essentials) and AKASA.
Does Medical Claims Recovery and Denial Solutions have an API?
No public API is recorded for Medical Claims Recovery and Denial Solutions.
What industry is Medical Claims Recovery and Denial Solutions in?
Medical Claims Recovery and Denial Solutions's product category is Healthcare Revenue Cycle Management. Its primary akta.pro industry code is HLACACAH, Denials Management & Appeals, with a secondary code of FSAKAJAM, Medical Debt Collection & Revenue Cycle Bad-Debt Recovery. Its NAICS code is 56144 and its SIC code is 8000.