Claims recovery and revival
We recover denied, rejected, underpaid, unpaid, delayed and partially paid claims, including claims returned for more documents.
Mogadishu
Your Revenue. Our Mission.
Claim Solutions is a health insurance third party administrator (TPA) that manages health insurance claims from start to finish: pre-authorisation, claims processing, contract negotiation and recovery of unpaid claims, for healthcare providers, insurance companies and insured clients.
Healthcare providers
- Insurance Billing and Claims SubmissionPreparing accurate invoices and claim files, submitting them to insurers and tracking each one until payment is received.
- Insurance Company and Provider Relationship ManagementActing as the link between your facility and insurers, managing contracts, tariffs and day-to-day communication.
- Pre-authorisation and Guarantee of Payment CoordinationRequesting and following up pre-authorisations and Guarantees of Payment (GOP), so patients can be treated without delay.
- Denied Claim Appeals and Dispute CoordinationReviewing denied or underpaid claims, preparing appeals and working with insurers to resolve disputes and recover payment.
Insurance companies
We administer health claims accurately, so you pay the right amount on time.
- Claims Processing and ReviewChecking each claim against policy terms, agreed tariffs and medical necessity, then processing it for accurate and timely payment.
- Pre-authorisation and GOP HandlingReviewing treatment requests and issuing pre-authorisations and Guarantees of Payment (GOP) to hospitals, so members get care without delay.
- Provider ManagementBuilding and managing your network of hospitals and clinics, negotiating contracts and tariffs, and monitoring provider quality and billing.
Insured clients
We help you get reimbursed when your claim is delayed, cut or denied.
- Claim File Review and PreparationReviewing claim documents for accuracy, completeness, and compliance with insurance requirements.
- Claim Submission and TrackingSubmitting claims to insurers, monitoring progress, and following up on pending payments.
- Claim Appeals and Denial ResolutionAppealing denied or underpaid claims and coordinating with insurers to seek reconsideration and reimbursement.
- Medical Concierge ServicesProviding personalized assistance in finding hospitals, arranging appointments, and navigating healthcare services.
About us
We make health insurance claims work for everyone involved.
Claim Solutions is a health insurance third-party administrator and claims management company based in Mogadishu, Somalia.
We identify unpaid, denied, delayed, rejected, underpaid and disputed medical claims, and work with healthcare providers and insurers to resolve them. We also assist insured individuals whose medical claims have been denied or underpaid.
Our principle: healthcare providers should receive the full and fair reimbursement they are entitled to.
Vision
To become a leading healthcare claims management and revenue-recovery partner in Somalia and the wider East African and international healthcare market.
Mission
To improve healthcare providers' financial performance by combining medical expertise, insurance knowledge, claims analysis, technology and persistent payer follow-up to recover revenue that would otherwise be lost.
Our services
Eight services across the full claims cycle.
Use one service on its own, or combine them into a complete claims programme.
Recover
Get paid for claims that were denied, cut or never answered.
Denial management and appeals
We prepare reconsideration requests, appeals and corrected claims, backed by medical justification and documentation.
Underpayment recovery
We compare payments against contracts and tariffs, verify allowed amounts and recover outstanding balances.
Insurance claims audit
We review payments for tariff discrepancies, incorrect deductions and exclusions, coding errors and unjustified denials.
Manage
Keep every claim moving, from approval to payment.
Pre-authorisation and GOP support
We handle Guarantees of Payment and approvals for treatment, surgery and admission, including extensions and high-cost requests.
Insurance follow-up and accounts receivable
We verify claim status, follow up on payments and missing documents, review EOBs and escalate long-outstanding claims.
Advise
Fix the causes, so fewer claims fail in the first place.
Contract and tariff negotiation
We support tariff analysis, contract review, service pricing, negotiation preparation and provider network applications.
Medical coding and documentation review
We review ICD-10 and procedure coding, medical necessity and the consistency of diagnoses, reports and test results.
Our pricing
Clear fees, agreed before we start.
Clients with a contract pay according to their agreed tariffs, whether we handle a batch of claims and pre-authorisations or a single case.
New clients receive a quote based on the type and volume of work. There are no hidden charges, and every fee is confirmed in writing before any work begins.
How the fee is calculated
- Batch of claims / pre-authorisations
Per agreed tariffs for contracted clients, and negotiated rates for new clients.
New clients: request a quote - Single cases
Per agreed tariffs for contracted clients, and negotiated rates for new clients.
New clients: request a quote
How we work
Eight steps from portfolio to payment.
Every claim follows the same clear path, so you always know where it stands.
Portfolio assessment
We receive and analyse your outstanding claims.
Claims classification
We sort claims into denied, rejected, underpaid, unpaid, delayed or disputed.
Documentation review
We check the medical and insurance documents behind each claim.
Recovery strategy
We choose the right recovery path for each claim.
Payer engagement
We communicate with the insurer and follow up on every claim.
Appeal or resubmission
We prepare corrected claims, reconsiderations or appeals where needed.
Payment verification
We confirm that each payment received is correct.
Recovery reporting
We report what was recovered, what is pending and what cannot be recovered.
Reporting
Clear reports, every month.
Every client receives a written report each month showing what has been recovered, what is still open, and why claims are being denied, so you always know where your money stands.
Claims by statusClaims by insurerAgeing of unpaid claimsDenial reasonsUnderpayments foundPayments receivedOutstanding balances
What each report shows
Recovery rate
Share of recoverable claims successfully recovered.
Recovery value
Total amount recovered for you.
Average recovery time
How long it takes to resolve a claim.
Denial rate
Share of claims denied by payers.
Underpayment recovery
Money recovered from incorrect or short payments.
Aged receivables reduction
How much your old insurance balances have fallen.
Why Claim Solutions
A specialised team focused on getting claims resolved.
Providers lose revenue through slow follow-up, staff shortages, coding errors, missing documents, unresolved denials and expired deadlines. We bring four strengths to fix that.
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Medical knowledge
We understand diagnoses, treatments and the records that support them.
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Insurance expertise
We know how policies, tariffs and approvals work.
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Claims analytics
We find the patterns behind denials and short payments.
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Persistent follow-up
We stay with every claim until it is resolved.
Our core values
Integrity
We operate transparently and protect the interests of our partners.
Accountability
We take responsibility for the claims entrusted to us.
Persistence
We do not give up on legitimate claims because they are difficult.
Accuracy
Every claim is reviewed carefully and professionally.
Confidentiality
Patient and financial information is handled with strict confidentiality.
Results
Our success is measured by the value we create for our clients.
Your records stay protected.
Patient and financial information is handled with strict confidentiality. Client records are used only to process and recover claims, access is limited to the team members working on that client's portfolio, and confidentiality terms are part of every client agreement.
Contact
Start with your outstanding claims.
Tell us who you are and what you need, and we will send you a clear quote.
Email
info@claimsolutions.so
Phone / WhatsApp
+252 61 090 4002
Message us on WhatsAppOffice
Buulo Xuubey Road, Wadajir District, Mogadishu, Somalia