Notes on payer behavior
Underpayment recovery for independent specialty practices: how to choose (2026)
Suppose you've run the afternoon check, or you just suspect your payers' remittances wouldn't survive a line-by-line comparison against your contracts. An independent specialty practice has four real options. We sell one of them. Read this knowing that; we've tried to be fair to the other three.
Option one: do nothing
This is the default, and at the single-claim level it's rational. One underpaid line is often tens of dollars, and chasing it never pays for the time. Where it fails is the aggregate. Systematic shortfalls multiply across a year of volume, and the clocks run regardless. In Florida, underpayments on fully-insured business stay claimable for 12 months from payment; most payer dispute windows are shorter still. Doing nothing is a decision to let the oldest month expire, every month.
Option two: work it in-house
The right answer more often than a recovery firm likes to admit. If the pattern is one payer and one or two codes, a capable biller can file reconsiderations through the payer's own process. Budget honestly, though: documentation, contract citations, and follow-up over one to three months per batch, all hours that come out of the same team keeping current claims moving. Where in-house breaks down is scale and detection. Recomputing every remittance line against every contract's fee schedule is a systems job, not a spare-hours job, and the pursuit work grows with whatever detection turns up.
Option three: buy software
Contract-modeling and underpayment-detection platforms load your fee schedules and flag variances automatically. MD Clarity is a fair example of the category done well: software-first (contract modeling, expected-pay calculation, variance worklists), with a services arm generally oriented toward larger groups and MSOs. Software is the right fit when you have revenue-cycle staff to work the queue it produces. The tool finds the variance; a person still has to pursue it. Subscription economics also reward claim volume. The per-month cost is easier to justify at MSO scale than at a 3-to-15-physician practice.
Option four: a contingency recovery service
A firm audits the remittance history, builds the cases, pursues them with the payers, and gets paid a percentage of what actually comes back. The trade: a share of the recovery in exchange for zero internal hours and pattern expertise you'd otherwise build from scratch. The built-in honesty of the model is that the firm eats its own false positives. It only earns on what payers actually repay.
What to ask any vendor, including us
- Fee structure. Subscription, percentage, or both? What triggers a fee: findings, filings, or funds received?
- Who does the work. Does the vendor's team pursue the money, or does your staff work a queue the vendor produces?
- What happens to your data. Where does your remittance data live, what happens to it when the engagement ends, and is it used for anything beyond your engagement?
- Minimum size. Much of the market is calibrated to health systems and MSOs. Ask directly whether a practice your size is a fit or an accommodation.
- What they refuse to pursue. The most revealing question. A vendor that appeals everything is spending your payer relationships on unwinnable claims. A correctly denied claim, or a correct contractual adjustment, should never be disputed. Ask for their version of a legitimacy check.
- Florida specifics, if that's where you practice. Do they work the 12-month statutory underpayment window, the prompt-pay interest provisions, the per-payer appeal clocks, the workers' comp petition rail? Generic national playbooks leave state law on the table.
Where Clearia fits
Clearia is option four, built for the segment the market tends to skip: independent practices across specialties and ambulatory surgery centers, with Florida statutory depth and contingency-only pricing. The diagnostic that starts an engagement is free, and it produces the same thing this note says you should get from anyone: findings in dollars, before any commitment. If your situation reads more like option two or three (a single-payer pattern, or MSO-scale volume with in-house analysts), those are the better answers, and we'll say so.