Found Money: the coverage finder for your self-pay book

The leak

A patient pays self-pay at the visit. Or owes a balance you never collect. Sixty days later, one of three things happens that you never find out about:

1. Medicaid approves them retroactive to the date of service.
2. Their secondary insurance kicks in (forgot to mention it at intake, COBRA, employer benefits).
3. Workers’ comp gets assigned after a delayed claim adjudication.

In every case, there is eligible coverage that should be billed. In every case, the money is already yours. You just stopped asking the question because the lookup was too tedious to do by hand.

A 25-practice billing company runs 2,000 to 3,500 of these eligibility windows a month across its book. Manually checking each one across state Medicaid portals, commercial carriers, and workers’ comp boards is 400 to 600 person-hours a month. Most billing operations don’t do it. The money quietly leaves.

The agent

Found Money is the eligibility-finder workflow inside NxtPivot. It watches your self-pay book and runs the eligibility queries automatically:

• 270/271 EDI against state Medicaid for retro-eligibility.
• Commercial carrier eligibility for secondary coverage the patient didn’t disclose at intake.
• Workers’ comp board lookup for delayed work-injury assignment.

It learns which patient cohorts produce hits, shifts its query cadence to maximize hit-rate per call, and queues confirmed-coverage patients for rebilling. Found Money doesn’t try to bill the new payer itself, your team still reviews and submits. It just makes sure the question gets asked, every patient, every billable window.

Before / after

	Today	With Found Money
Coverage discovery cadence	Anecdotal, when patient calls in	Every patient, every cycle
Per-patient lookup time	12 to 20 min	< 5 sec
Person-hours per 500 lookups	~100	~4 (edge-case review)
Recapture volume visibility	Per-anecdote	Per-cohort, per-state, per-payer
Throttle-aware?	No	Yes, learns optimal cadence

The math at one customer

A western-US billing company running 25 practices.

• Before: 84 retro-Medicaid recaptures in March, $19,400 recovered, ~110 person-hours.
• After three months on Found Money: 211 recaptures in March, $47,300 recovered, ~8 person-hours. Plus an additional $9,200 in secondary-coverage recaptures the team had never been chasing.

Net delta: $37,100 in additional monthly revenue, ~100 person-hours freed up. The math holds at any reasonable scale because the per-patient cost approaches zero once the agent is running.

Why this is the highest-ROI workflow to automate first

Three reasons most billing companies should start here, not with denial recovery:

1. The dollar amounts are bigger. A coverage recapture is often the full claim ($250 to $400). A denial recovery is usually the contractual difference ($40 to $120).
2. The win rate is higher. Once coverage is confirmed, the rebill succeeds nearly every time. >95% conversion to paid. Denial appeals: 70 to 80%.
3. The work doesn’t compound. Once Found Money is current on your self-pay book, it stays current. Denial queues refill faster than you can drain them.

For most billing companies, Found Money is the demo that pays for the pilot in the first 30 days. Denial recovery is the headline. Found Money is what pays the bills.

Where to start

Three numbers tell you whether the leak is real in your operation:

1. Self-pay balance written off in the last 12 months. How much of that should have been Medicaid, secondary, or workers’ comp?
2. Recaptures logged last month. Compare to your peers, most underestimate by 3 to 5x.
3. Person-hours spent on portal lookups last month. Ask the team that does it. They will know.

If you can answer any of these with confidence, you already know whether Found Money is worth a pilot conversation.