Our Underpayment System Analysis Audit is a proprietary system that identifies and recovers underpayments, manages denials and overpayment fines and responses, automates appeals and requests, and is a contract modeler essential in negotiating more favorable contracts for the future. We cover all the costs and risks, including contract load fees, appeals, audit, and training which is applied to our recovery fee. Fees are 100% paid by a percentage of recovered underpayment fees from the initial audit of past claims. Once we have received all contracts and data files, it typically will take around 14 days to complete the analysis and start the appeals process.
The Underpayment System historically uncovers 5-30% of commercial payments which have been paid incorrectly on every analysis. Our collection statistics for commercial payer underpayments are 85-90% of identified claims. Most contracts allow providers to appeal claims that have been underpaid or paid incorrectly for up to 12 months from the last response by the insurer. After 12 months, they will expire, at which point you can never bill or collect. Our system recovers additional underpayments owed on zero-balance accounts. Dollars underpaid after EMR/EHR and billing systems have fully processed claims as “PAID IN FULL.”