How it works

How the recovery works.

Three steps: a free diagnostic built from records you already have, findings in dollars you approve line by line, then recovery through each payer's own reconsideration process. Here is the whole thing — including what the reports look like.

Request the free diagnostic no cost until dollars are recovered

What we're looking for

Underpayment survives because nothing flags it:

Payments a few percent under the contracted rate — small enough to post without a second look.
Procedures paid at a lower-valued code than the one your physicians billed.
Line items bundled or denied that your fee schedule says are payable.
Renegotiated rates that never reached the payer's system — you signed a better contract; the payments didn't change.

Each claim closes at zero balance. No alert fires. And payer dispute windows run out in 90 to 180 days — what stays unnoticed long enough becomes unrecoverable, permanently.

The process

Free diagnostic. We sign a business associate agreement first. Then, from records you already have — your electronic remittances and payer contracts — we audit what each insurer paid against the contracted rate, code by code. 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. You decide what we pursue — nothing is filed without your sign-off.
Recovery. We pursue the approved underpayments through each payer's own reconsideration process and report every dollar as it lands. Our fee is a percentage of what's actually recovered. 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 to the specific reason each dollar went unpaid:

The recovery opportunities behind it — 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

Step two's deliverable: recoverable dollars identified in paid claims, traced to the payer behavior behind each one — a high rate signals 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 remittances confirm it, and what sits in each stage of the pipeline — a window into our work, not software you run. Sample engagement, synthetic data.

The standard we work to

Read-only. We analyze payment records. We never touch your billing workflow, your claims, or your payer relationships.
HIPAA-first. A business associate agreement is signed before any data moves; everything travels through covered channels.
Your sign-off, always. You see every finding and decide what we pursue; appeals go out under the practice's name.
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, and every engagement decision stays yours.

Request the free diagnostic or write to contact@cleariagroup.com