underpayment-detection

Payer underpayment detection compares actual reimbursements from ERA 835 remittances against contracted rates and expected payment calculations to identify payment variances. It flags claims reimbursed below agreed fee schedules for recovery.

Payment variance analysis is the process of comparing actual payer payments against expected amounts based on fee schedules and contracts. It identifies underpayments, pinpoints root causes like incorrect rate application, and helps recover lost revenue.

Yes, you can audit Medicare Advantage remittances against Medicare fee schedules and contracted rates. The analysis validates expected payments, flags claims paid below contracted rates, and suggests appeal strategies for recovery.

Performing a payer audit requires structured remittance data, contracted rates, claim details, payer contracts, and Medicare fee schedules. These inputs enable comprehensive comparison and validation of actual payments against expected amounts.

Prioritize underpayment recovery by ranking identified variances based on financial impact and recovery feasibility. This approach highlights the top recovery opportunities, ensuring teams focus on claims with the highest potential return.