Stop Writing Off Revenue You're Entitled to Recover
MOOP Management monitors your Medicare Advantage dual eligible accounts and holds crossover claims, notifying you the moment the max out-of-pocket threshold is met so Medicare pays at 100% instead of you writing off the balance.
Where revenue quietly disappears.
The Mistake
What It Costs You
THE FIX: MOOP Management flags every account before a bill is filed and monitors the claim until the deductible or max out-of-pocket is met.
How It Works
Upfront Analysis
Send your claims file. We identify which accounts have already met their deductible or max out-of-pocket and flag any demographic corrections — before a bill is ever filed.
Real-Time Monitoring
Claims with unmet deductible or max out-of-pocket enter our live monitoring queue. We track each claim as other providers bill against the same patient's insurance, watching for when the threshold is reached.
Automated Notification to Bill
Once the patient's deductible or max out-of-pocket has been satisfied, you receive an electronic notification to submit the claim to the payer at 100% of Medicare fee schedule.
What we hold, and what happens to it.
What % do we hold?
On average, we hold 19% of claims submitted, depending on time of year.
Of the 19% held, what % reach the deductible or max out-of-pocket threshold?
The Outcome
Key metrics from the MOOP pilot — Ohio, Medicare / Medicare HMO, Q1–Q4 2025.
Results from a single client engagement — midsize ambulance agency, Ohio.
Pilot Results
Each pilot below reflects results from one client engagement — not aggregate SGS performance. Individual results vary by book of business, payer mix, and time of year.