Underpayment Identification Services

Underpayments are the most invisible form of revenue loss because the claim looks fine: it was paid, posted, and closed. The problem is the number — a payment 4% below the contracted rate, an incorrectly applied multiple-procedure reduction, an outdated fee schedule in the payer’s system. Multiply small variances across thousands of claims and the total is material.

Our underpayment workflow loads your contracted rates, compares actual allowed amounts line by line, and pursues variances through reprocessing requests and, where needed, formal disputes — with reporting that shows recovery by payer and cause.

Problems This Service Addresses

• Payments below contract rates absorbed silently as contractual adjustments
• Fee schedule updates never verified against actual payer behavior
• Multiple-procedure and modifier reductions applied incorrectly
• No systematic comparison of paid versus contracted amounts

What’s Included

• Contract and fee schedule loading for major payers
• Line-level paid-versus-expected variance analysis
• Reprocessing and adjustment requests with contract citations
• Underpayment dispute escalation where reprocessing fails
• Recovery reporting by payer, code group, and cause

Who This Service Is For

• Practices that have never audited paid claims against contracts
• Groups with significant commercial contract volume
• Administrators who suspect “paid” does not mean “paid correctly”

Risks and Operational Considerations

Detection requires your actual contracts and fee schedules — if the practice cannot locate current contracted rates, that discovery process is step one and is valuable in itself.

Some variance causes are contract interpretation disputes rather than errors; those may need escalation paths the practice controls, including contracting conversations.