A paid claim is not necessarily a correct claim.
We help hospitals identify, explain, and address the difference between what payers remit and what the governing terms require.
Evidence, not assumptions.
Claim and remit data can reveal persistent underpayment patterns, unexpected adjustments, policy applications, and inconsistencies that aggregate reporting misses.
Contract-to-claim testing
Compare expected reimbursement to actual paid amounts using applicable contract provisions.
Variance analysis
Identify differences across payers, service lines, codes, and dates of service.
Dispute documentation
Assemble claim-level evidence, accounting support, and the questions needed to obtain a substantive response.
Root-cause review
Separate isolated claim errors from systemic methodology or operational issues.
Stop the leakage. Recover the past. Monitor the future.
Collect
Review available 837 claims, 835 remittances, and relevant contract terms.
Analyze
Reconcile expected versus observed adjudication at the appropriate detail level.
Resolve
Support claim validation, correction, and financial reconciliation.
Watch
Track recurring patterns and changes in payer performance.
A clearer picture of payer performance.
Bring the contract and the payment into the same conversation.
Discuss an underpayment issue or broader payer performance review.