Audit
We price every paid claim against the contract you signed.
Where revenue hides
The way payers pay changed. Hospital reporting hasn’t.
Paid claims hide 1% to 3% of net patient revenue in underpayments payers consider closed. Payers no longer deny outright — they partial-pay, bundle, and reprice so the loss hides inside a claim that already cleared.
Sources: HFMA; Becker’s Hospital Review; FinThrive HFMA 2025 analysis (117 providers).
For a hospital with $100M net revenue, that translates to $1M – $3M, already accepted as final.
What your billing stack can’t see
EMR. Clearinghouse. Contract. One platform.
- EMRCharges, encounters, and billed codes.
- ClearinghouseSubmitted claims, payer responses, denial reasons.
- Fee schedulesPayer contracts, modifiers, and bundling rules.
Contract rates matched to every claim and remit.
How we find it
Every claim priced to the penny.
Pick a claim. We price it against your actual contract: bundling rules, modifiers, and carveouts included.
- Contract owes$9,210
- Payer paid$7,450
- Gap−$1,760
The femoral component was bundled into the surgical fee. Per contract, implants carve out and reimburse at invoice cost plus handling.
Contract reference: Aetna PPO master agreement, §4.2, Implant carve-out (invoice cost).
Revenue OS
Payers, departments, providers: ranked by gap.
Contracts, claims, and remits in one place. Every dollar has an expected value. Every shortfall has a source.
- Underpayments found$820K+18% vs last yearyear to date
- Top payer gap$340KAetnaflagged this quarter
| Payer | Claims | Posted | Expected | Gap | Denial % |
|---|---|---|---|---|---|
| Aetna | 3,420 | $3.86M | $4.20M | −$340K | 11% |
| BCBS | 2,280 | $2.97M | $3.10M | −$130K | 7% |
| UHC | 1,840 | $2.65M | $2.70M | −$50K | 9% |
| Cigna | 1,360 | $1.85M | $1.90M | −$50K | 8% |
| Other (6) | 2,720 | $3.85M | $4.10M | −$250K | 9% |
| Total | 11,620 | $15.18M | $16.00M | −$820K | 9% |
All payers, this year. Sorted by gap.
Ask anything
One question. The math, the contract, and the appeal.
- Patterns flagged the moment they emerge — linked to the contract clause and the claims.
- Appeal letters drafted and queued. Your team reviews and sends.
From signature to live
Proof in 30. Live in 90.
- Day 30Recovery
We reprice 12 months of closed claims against your contracts. Within 30 days, you see exactly what is recoverable.
- Day 60Connect
Read-only access to your EMR, clearinghouse, and fee schedules.
- Day 90Deploy
Live dashboards. A prioritized recovery queue. Briefs to leadership every Monday.
Read-only database access. No write access, ever.
Your billing team works exactly as they do today.
SOC 2 / HIPAA / BAA ready.
See it live.
A 30-minute walkthrough. We show you where the gaps are — before you commit to anything.