Solutions
Recover lost revenue through contract analysis, fee schedule auditing, payment variance detection, and payer negotiations. Our underpayment recovery services identify reimbursement gaps before they become permanent losses
Get Your Free RCM Assessment →Insurance underpayments rarely happen because a payer forgot to pay. They happen because contracts, fee schedules, reimbursement logic, and payment calculations are applied differently. We compare what was paid against what should have been paid and recover the difference.
Every payment is verified against negotiated payer contracts and reimbursement terms.
Commercial, Medicare, Medicaid, and managed care fee schedules are continuously validated for payment accuracy.
Olympus identifies reimbursement variances across CPT codes, providers, locations, and payers.
Recover missed reimbursement opportunities from incorrectly paid out-of-network claims.
Supported by contract language, payment calculations, and payer-specific documentation.
Executive dashboards highlight recovered revenue, payer trends, and recurring payment leakage.
Every payment is analyzed automatically. Our AI identifies reimbursement discrepancies, while our reimbursement specialists recover what you're owed
Every ERA is matched against expected reimbursement using payer contracts, fee schedules, and historical payment patterns.
AI identifies opportunities. Specialists validate calculations, prepare appeals, and negotiate directly with payers until resolution.
Track reimbursement performance across contracts, payers, specialties, and provider groups from one dashboard.
Every ERA and EOB is reconciled against contracted reimbursement before payment variance accumulates.
Fee schedules, payer contracts, and reimbursement updates are tracked continuously to keep recovery calculations accurate.
High-value underpayments move directly to senior reimbursement specialists for negotiation and resolution.
Every engagement begins with a reimbursement assessment. We benchmark payment performance, identify leakage by payer and contract, and build a recovery strategy that improves future reimbursement, not just today's recoveries.
Then we execute.
"We don't recover missing revenue once. We build a system that prevents it from disappearing again."
ERAs, EOBs, and payer contracts are imported and normalized.
Payments are compared against expected reimbursement.
Specialists validate discrepancies and prioritize recovery.
Payer-specific appeals are submitted and actively pursued.
Recovered revenue is reconciled and verified.
Recurring underpayment patterns are monitored to reduce future leakage.
Underpayments occur when payers reimburse less than the allowed contracted amount. Causes include calculation errors, incorrect code processing, missing components, payer system errors, bundling issues, and lack of proper verification of payment amounts against contracts.
Plutus Health identifies underpayments through systematic EOB review, claim-to-payment matching, contracted rate verification, detailed analysis of bundled claims, error pattern tracking, and automated alerts for anomalies in payment patterns by payer and code.
Appeal process includes documentation of the discrepancy, calculation of correct payment amount, gathering supporting documentation, preparing formal appeal letters, submitting through proper channels, follow-up with payers, and persistence until resolution.
Recovery rates vary but healthcare organizations typically recover 20-40% of appealed amounts. The exact amount depends on claim volume, underpayment frequency, appeal success rates, and complexity of issues involved.
Plutus Health identifies systematic underpayment patterns, calculates accurate recovery amounts, manages the full appeal process, tracks payer responses, escalates unresolved cases, and provides detailed reporting on recovery results and trends.
Our 30-day revenue diagnostic benchmarks your reimbursement performance, identifies underpayments, and quantifies recoverable revenue before you commit.