How it works

How the recovery works.

Three steps. A free diagnostic built from records you already have, findings in dollars you approve once, then recovery we file on your behalf through each payer's own reconsideration process. The whole thing is laid out below, sample reports included.

Request your free diagnostic no cost until dollars are recovered

What we're looking for

Underpayment hangs around for one reason. Nothing flags it:

Payments a few percent under the contracted rate, small enough that they post without a second look.
Procedures paid at a lower-valued code than the one your physicians actually billed.
Line items bundled or denied even though your fee schedule says they're payable.
Renegotiated rates that never reached the payer's system: you signed a better contract, and the payments never changed.

Each claim closes at zero balance. No alert fires. Nobody's job is to notice. And payer dispute windows run out in 90 to 180 days, so whatever goes unnoticed long enough is gone for good.

The process

Free diagnostic. We sign a business associate agreement first. Then we take records you already have (your electronic remittances and payer contracts) and check what each insurer paid against the contracted rate, code by code. A person on our side reads your remittances. Your team's part takes about an hour.
Findings, in dollars. You get a line-item accounting: which payer, which codes, which claims, how much, and what's still inside the dispute window. Then you decide what we pursue, by pattern and by insurer. One approval, and that's the whole engagement.
Recovery. We file the appeals and reconsiderations ourselves, as your authorized representative, and tell you about every dollar as it lands. Our fee is a percentage of what actually comes back. Nothing else, ever.

From the diagnostic report sample · synthetic data

Where the recoverable dollars come from. In this sample quarter, $247,800, traced from its two categories down to the specific reason each dollar went unpaid:

The recovery opportunities behind it, with how often each pattern fires and what it's worth:

Arthroscopy paid below the contracted rateCO-45 · knee & shoulder · multiple payers

47%of arthroscopy claims

$48.2K
Level-4 office visits downcoded to level 399214 → 99213 · documentation supports the billed level

34%of 99214 claims

$31.6K
Same-day procedure bundled into the office visitCO-97 · modifier 25 supports separate payment

38%of modifier-25 eligible

$22.4K
Denied for no prior authorization on fileCARC 197 · administrative, obtainable retroactively

22%of auth-required claims

$18.9K
Denied as missing informationCO-16 · correctable data defect, resubmit

19%of denied claims

$14.3K

This is step two's deliverable: recoverable dollars found in paid claims, each traced to the payer behavior behind it. A high rate means a systematic pattern, not a clerical slip. Sample report, synthetic data.

During the engagement sample · synthetic data

Recovered to date$151,840net of our fee · five months in

In progress$35,580drafted & submitted, not yet paid

Recovery rate81%of submitted appeals, paid

Month 1234Month 5

$5,980Identifiedlive · not yet drafted

$11,400Draftedlive · in review

$18,200Submittedlive · awaiting payer

$151,840Recoveredcumulative, five months

Step three, ongoing. Every recovered dollar as the remittances confirm it, plus what sits in each stage of the pipeline. It's a window into work our people are doing, not software you run. Sample engagement, synthetic data.

The standard we work to

Read-only in your systems. We read payment records. We never touch your billing workflow, your claims, or your payer relationships.
HIPAA-first. A business associate agreement gets signed before any data moves, and everything travels through covered channels.
Your scope, our filing. You see every finding and set the scope once. Then we file as your authorized representative, under the practice's name, and you get a record of everything that goes out.
Auditable. Every dollar we recover comes with the paper trail that proves it: the finding, the contract language, the appeal, and the remittance that closes it.

More on how we work, and the standard behind it →

Start with the diagnostic

The next step is an hour, not a commitment.

The diagnostic is free. Every decision after it is yours.

Request your free diagnostic or write to contact@cleariagroup.com · LinkedIn