underpayment-detection

What problem does it solve?

This Skill identifies and helps recover revenue lost due to healthcare payers reimbursing claims below contracted rates or expected payment amounts.

Core Features & Use Cases

• Underpayment Identification: Compares actual payments against contracted rates, fee schedules, and calculated expected payments.
• Root Cause Analysis: Classifies the reasons for underpayments (e.g., wrong fee schedule, incorrect modifier processing).
• Recovery Prioritization: Helps prioritize underpayments for appeal based on dollar amount and contract violation severity.
• Use Case: Automatically audit all Medicare Advantage remittances for a specific quarter to identify claims paid below contracted rates and generate a prioritized list for appeals.

Quick Start

Analyze the provided remittance data against contracted rates to identify and list all underpaid claims.