Revenue Recovery

The claim closed. It still paid short.

Every remittance is compared, line by line, against the rate you actually negotiated. What comes out is two queues: claims still carrying a balance, and claims already closed and paid in full — where a shortfall is money nobody in your organisation is working.

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Compared against your contracts
Two queues, no double counting
Patient balances never counted

Revenue Recovery workspace showing 691 claims reviewed, $26,757 in underpayments identified, and recoverable dollars broken out by payer and service line.

Both recovery queues in one view: claims reviewed, underpayments identified, the recoverable amount, and where it sits by payer and service line.

What it does

Checks against your rates

Each service line is measured against what that payer agreed to pay for that procedure — so a payer that has loaded a code wrong is caught everywhere it touches, not once by luck.

Names the cause

A shortfall is classified as bundling, a contract variance, an unhonoured modifier, a multiple-procedure reduction or a plain fee-schedule difference — so you know which conversation to have.

Separates new money from old

Variance on an open claim is a contract shortfall on receivable you already track. Variance on a closed claim is entirely new. The product never lets you add the two together.

Shows what is worth chasing

Findings carry a confidence rating and an expected recovery, so a marginal one-off never sits at the same weight as a pattern repeating across dozens of claims.

How it works

1
Your contracts go in
Negotiated rates by payer and procedure become the yardstick every remittance is measured against.
2
Every remitted line is checked
Expected against allowed, at line level, so a shortfall buried inside a partially paid claim still surfaces.
3
Findings are explained and rated
Each one arrives with a cause, an expected recovery and the evidence you would need to dispute it.
4
You work it or dismiss it
Review, confirm or dismiss, assign an owner, and push what you are keeping onto the worklist.

Zero-balance is where the unworked money is

A claim that closed at zero looks finished to every report you have. If the payer allowed less than your contract says, that gap was never a receivable, never appeared in A/R and never reached anyone's queue. It is the one pool where a recovered dollar is genuinely new.

Findings on open claims are labelled as variance on receivable you already track, so nobody counts the same dollar twice in a forecast.
Findings on closed claims are labelled as money outside A/R that no queue is working.
The two populations never overlap — a claim belongs to exactly one of them.
On a claim the payer paid rather than denied, the dispute clock is measured from the remittance, so you can see how much window is left.

Two queues

Underpayment Analysisopen balance
The payer remitted but a balance remains. The variance is contract shortfall, not additional receivable.
Zero-Balance Reviewclosed
Paid in full, nothing outstanding. A shortfall here is money nobody is currently working.

It refuses to flatter the number

The easiest way to triple an underpayment headline is to sweep patient responsibility into it. A deductible balance is money the member owes, not a payer shortfall — and in most books it dwarfs the real variance. It is excluded, and the page says so.

Deductible, coinsurance and copay balances are kept out of every underpayment figure and reported separately.
Published government rates are treated differently from negotiated ones — you cannot be underpaid against a public fee schedule the way you can against a contract.
Differences small enough to be normal contract rounding are not raised as findings.
Claims that paid correctly stay visible in the queue, so a reviewer can see the detector working rather than only its hits.

What is deliberately excluded

Patient responsibility
A deductible or coinsurance balance is the member's, not a payer underpayment.
Published fee schedules
Government rates are not privately negotiated ones.
Immaterial variance
Differences inside ordinary contract rounding.
Balances not worth working
Where the cost to collect exceeds the recovery.

Built for the payer conversation

A list of suspected underpayments is not leverage. What moves a payer is a repeating pattern with the numbers attached — the same procedure, the same contract, priced short across a run of claims.

Findings roll up by payer and procedure, so a systemic pricing error reads as one issue rather than forty separate ones.
Breakdowns by payer, service line and month show where variance concentrates and whether it is getting worse.
Each finding names the evidence a dispute needs — the executed fee schedule, the remittance, the line-level worksheet.
Queues export with expected, allowed, variance and cause, ready to send.

Causes it distinguishes

Contract variance
Paid below the payer's own stated allowed amount.
Fee schedule variance
No adjustment code explains the shortfall.
Bundling
A payable line allowed nothing at all.
Modifier not honoured
The shortfall sits on lines carrying a pricing modifier.
Multiple procedure reduction
Secondary surgical lines absorbed the reduction.

Two queues

Open balance and zero balance

Kept separate so nothing is counted twice

Line level

Every remitted line checked

Against the rate you actually negotiated

Explained

Every finding names its cause

Bundling, contract variance, modifiers and more

Net of noise

Patient balances excluded

A deductible is not a payer underpayment

Common questions

What is the difference between the two queues?: Underpayment Analysis covers claims that still carry a balance — that money is already in your A/R, and the variance shows how far below contract the payer's allowed amount fell. Zero-Balance Review covers claims already closed and paid in full, where a shortfall is money outside A/R that nobody is working.
Can we add the two totals together?: No, and the product says so on the page. The open-balance figure overlaps receivable you already track; only the zero-balance figure is genuinely incremental. Adding them is the most common way an underpayment number gets overstated.
What do you need from us to start?: Your remittance data and your contracted rates. The rates are the yardstick — without them a variance engine is guessing, which is why generic tools tend to surface noise.
What do we do with a finding?: Review it, confirm or dismiss it, assign an owner, and push what you keep onto the worklist — or export the queue with expected, allowed, variance and cause for a payer conversation.

Explore the rest of the platform

See Revenue Recovery run against your own claims.

We’ll walk your team through a live workspace using a sample of your data, and show exactly where the recoverable dollars are.

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