As of November 2026, TSI's complex claims service works hospital and physician claims owed by workers' compensation carriers, auto and liability insurers, the VA and TRICARE. Specialist teams find the responsible payer, gather accident reports, policy and attorney details, file liens where state law allows, follow payer deadlines and escalate disputed claims to legal and clinical reviewers.
Results vary by payer mix and client program.
- Accident report received
- Auto carrier and claim number verified
- Attorney of record on file
- Lien filed with county clerk, Oct 2
- Health plan billed as secondary: pending
- 1Auto PIP or med-pay
- 2Liability carrier
- 3Health plan
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
Why these claims sit
A motor vehicle claim can have three possible payers, an attorney and a settlement that's two years out. A workers' comp claim needs the employer, the carrier, the claim number and a state fee schedule. A VA claim needs the right authorization and the right claims administrator.
When these get worked by the same people, on the same cycle as a commercial claim, they age out.
The deadlines don't wait for the paperwork. In Texas, a provider generally must submit a workers' comp bill no later than the 95th day after the service, with narrow exceptions (28 Tex. Admin. Code 133.20). A Texas hospital lien has to be filed with the county clerk before money is paid out on the injury (Tex. Prop. Code 55.005). TRICARE's filing limit in the U.S. is 1 year from the date of service (TRICARE, October 2026). Miss one and the balance either goes to the wrong person, often the patient, or to write-off.
What's included
Motor vehicle and liability
Personal injury protection, med-pay and liability claims, with accident reports, policy details and attorney-of-record information gathered and tracked. Liens are filed once you authorize them, and letters of protection are tracked to the settlement.
Workers' compensation
Carrier and employer identification, state fee schedule and network discount checks, and corrected bills. Workflows keep the balance with the carrier or employer, off the patient.
VA and TRICARE
VA community care, TRICARE and TriWest claims for hospital and professional billing, worked to federal payer rules by staff trained on them.
Payer order and secondary billing
Coordination of benefits across auto, liability, health plan and government payers, so each claim goes to its primary payer first.
Legal and clinical escalation
High-dollar and disputed claims go to TSI's in-house legal staff and clinical appeals nurses, who review medical-necessity disputes against InterQual or Milliman criteria.
Litigation tracking
Accounts tied to a lawsuit, settlement or letter of protection are tracked by case status, with follow-up timed to the case and the attorney.
How it runs
Flag the account
Accident, injury and government accounts are identified from your financial class, accident indicators or registration data, ideally at discharge, before the bill drops.
Build the file
Specialists collect the accident report, carrier and claim number, employer details, authorizations and attorney information.
Bill the right payer
Claims go to the primary payer in the order the accident and state law set. Liens are filed where your state allows them and you authorize them.
Follow up on a set cycle
Every claim is reviewed at least every 28 days, more often when it's high-dollar or near a deadline.
Resolve or escalate
Disputes go to legal or clinical review. A patient balance moves to self-pay only once the third-party options are finished.
Where it fits with the other stages
Complex claims sit alongside extended business office follow-up on standard insurance. When an accident or VA claim is denied on clinical or technical grounds, it follows the denial management workflow with the specialist team still attached.
Self-pay accounts that turn out to be accident-related often surface during coverage discovery. Old accident claims stranded in a retired system get worked in a legacy AR run-out. When patient responsibility is final, the balance moves to early-out self-pay.
What you see
Weekly reports cover placements, recoveries by payer type, reconciliation and exceptions. Monthly dashboards show resolution rate, days from accident date or discharge to payment, net collections against billed charges, denial overturns, documentation accuracy and claims in litigation. High-balance and disputed claims come to you on an exception report for a decision.
Ask for days to payment by payer type. For Medicare patients, a liability insurer counts as paying promptly only within 120 days after the earlier of the claim or lien filing date and the service or discharge date (42 CFR 411.50). An accident claim that runs past that point needs a billing decision, and TSI flags it for you.
General information, current as of November 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The company behind the work
Questions buyers ask
What is complex claims recovery in healthcare?
Complex claims recovery is working hospital and physician claims owed by a payer outside the usual health plan, such as a workers' comp carrier, an auto or liability insurer, the VA or TRICARE, where payment depends on accident, employer, authorization or legal documents.
Who handles motor vehicle accident and workers' comp claims for hospitals?
Usually a specialist team, separate from standard insurance follow-up. TSI runs dedicated motor vehicle, liability, workers' comp and VA teams that work inside your systems in your hospital's name.
How do hospitals collect on auto accident claims with a liability settlement?
By billing personal injury protection or med-pay first where it applies, filing a hospital lien where state law allows, tracking the patient's claim and attorney, and collecting from the settlement or the health plan in the right order. Texas, for example, requires the lien to be filed with the county clerk before settlement money is paid (Tex. Prop. Code 55.005).
Do you file VA community care claims?
TSI follows up on VA, TRICARE and TriWest claims you've billed and rebills where needed. VA routes Community Care Network claims to Optum for regions 1 to 3 and TriWest for regions 4 and 5 (VA, October 2026), and the claim has to match the authorization.
Will patients get billed for workers' comp care?
Not while the claim belongs to the carrier. TSI's workflow keeps the balance with the employer or carrier, under your state's workers' comp rules.
How is complex claims work priced?
It's quoted by claim type and volume, once you share a sample of your open accident and government claims.
Find out what your accident and VA claims are worth
Choose one payer, such as a workers' comp carrier, and one denial class. The Denials Economics Sprint measures yield and cost per claim against your baseline, so you see where specialist follow-up pays back.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
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