Underpayment Recovery Services

Underpayment recovery is the process of identifying and reclaiming the full, contracted reimbursement when payers remit less than contractually agreed, often without formal notification.

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While sometimes easy to overlook compared to denials, underpayments still amount to meaningful and much-needed provider revenue. Both payer and provider errors can cause underpayments, but payers may exploit provider resource constraints, so it is essential for providers to routinely check all payments against contract terms. Depending on a provider organization’s resource levels and appeals experience, it can do this either via in-house revenue cycle staff applying specialized commercial software, or via outsourcing to a third party that combines software and services.

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Proactively addressing underpayments—especially when they cluster by treatment, location, or physician—not only maximizes revenue and supports financial stability but also reduces administrative burdens for healthcare organizations


Three main reasons:

• Denials are more visible: Where payers explicitly notify providers of denials, underpayments aren’t as easily identified. A reimbursement comes in, but staff often lack the time to verify it by hunting down the contract and calculating the contract-adjusted rate. The revenue cycle staff shortage impacting many providers further compounds this constraint.
• Staff face complex and constantly changing reimbursement methodologies: Contracts have exploded in intricacy over the past decade, requiring staff to have some knowledge of legal terms, financial principles, and data analysis methodologies. New value-based-care contracts that incorporate performance metrics, quality benchmarks, and risk-sharing arrangements add to the challenge. With each provider working with multiple insurers, and each insurer generating a variety of complex plans, even the most adept staff struggles to dive into the payment details.
• Payer bureaucracies are challenging to navigate: It’s not just the individual contracts that challenge revenue cycle staff. Payers often have complex, layered approval processes that create ambiguity in reimbursement decisions, too. Each insurer operates with distinct, often contradictory interpretations of contract terms and documentation requirements, forcing revenue cycle teams to navigate a patchwork of protocols without clear guidance. Recovery services experts have learned each payer’s conventions and how to navigate their red tape. Their finely-tuned negotiation tactics prompt payers to meet their contractual obligations without alienating them. Revenue recovery experts build reliable relationships with payers that benefit both sides long term. 


Some EHR and PM systems claim to identify and notify you of underpaid claims. But these platforms were not originally designed to parse and analyze the complex details of modern healthcare contracts and fee schedules, such as escalators, bundled procedures, carve-outs, and other nuanced payer rules. Nearly all providers find that those systems are not sophisticated or comprehensive enough to handle the full extent of payer reimbursement methodologies required to identify valid underpayments.

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Engineered initially to manage patient records and operational tasks, EHR/PM systems’ underpayment and contract management features are often recent add-ons and lack the depth needed to identify subtle but systemic reimbursement errors, leading to missed underpayments and revenue loss.

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EHR and PM underpayment functionality shortcomings force staff into time-consuming manual reviews to uncover issues that advanced contract management software can detect automatically, such as payer algorithm errors, incorrect fee schedules, and underpayments tied to specific codes or contract terms.

Provider organizations that manage a high-volume of complex claims and a large set of payer contracts with varied reimbursement models thrive with a two-pronged software and services approach.

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These provider organizations often face significant administrative burdens, intricate contract terms, and frequent payment discrepancies, making manual identification and recovery of underpayments inefficient and error-prone. By combining technology-enabled systematic underpayment identification with the deep knowledge of payer reimbursement experts, these organizations can efficiently detect, analyze, and recover underpayments to improve cash flow and gain actionable insights that support process improvement and contract negotiations.

MD Clarity surpasses competitors in underpayment recovery by combining advanced technology with the specialized expertise of payer reimbursement professionals. Our approach goes beyond basic underpayment detection. RevFind analyzes contracts and remittance data at the most granular level, identifying subtle payment variances that standard systems overlook. Then, our experts use this data to target and recover underpayments efficiently.

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Unlike many solutions that simply flag potential underpayments, MD Clarity’s team manages the entire process from discovery to recovery, providing an end-to-end underpayment recovery service. RevFind’s analytics simulate payer adjudication logic, surfacing hidden shortfalls across every charge and contract line, not just obvious discrepancies. Provider organizations gain actionable insights into underpayment patterns by payer, contract term, and service line, empowering them to address root causes and prevent future revenue loss.

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While other vendors focus narrowly on automation or a single revenue source, MD Clarity delivers a comprehensive recovery solution. In addition to underpayment recovery, it provides denial management, contract optimization, and patient financial responsibility software, all aimed at ensuring provider organizations capture every dollar they’ve earned.

Our contingency-based fee structure means that we are compensated when you recover underpayments. This performance-based approach aligns our incentives with your organization’s financial performance.