What Owed finds
Find payment gaps.
Owed checks your 835 remittances for 10 kinds of payment gap. Here's what each check uses, what it can tell you and what needs your review.
Paid less than agreed
Contract underpayments
A contract underpayment is a claim line the payer allowed for less than the rate in your contract for that payer, procedure code, clinician and date of service.
Paid at the wrong license tier
A credential-tier underpayment is a service by a doctoral-level or nurse practitioner clinician paid at a lower license tier's rate, usually because of an enrollment or credentialing error at the payer.
Downcoding
Downcoding is when the payer adjudicates a claim as a lower-level procedure code than the one billed, or reduces it because it says the documentation doesn't support the level of service.
Rate drops
A rate drop is an allowed amount below what this payer has recently paid you for the same code and clinician tier, when no contracted rate is on file to compare with.
Telehealth paid less
A telehealth gap is a telehealth service paid below the same payer's in-person rate for the same code and clinician tier.
Not paid at all
Recoverable denials
A recoverable denial is a claim denied with an adjustment reason code that's usually correctable or appealable, such as missing information, a coding mismatch or a missing authorization.
Wrong-payer denials
A wrong-payer denial is a claim denied because a different payer is responsible, often a behavioral-health company that administers the plan's mental health benefits.
Add-on code denials
An add-on code denial is an add-on service code denied as bundled with, or inconsistent with, its primary procedure code, even though the primary service was paid.
Taken back or paid late
Recoupments
A recoupment is money a payer takes back for what it says was an overpayment, by withholding it from a later payment instead of asking for a refund.
Prompt-pay interest
Prompt-pay interest is the interest a payer owes by law when it pays a clean claim late. In Tennessee, clean electronic claims are due within 21 days, with interest at 1% a month after that (Tenn. Code Ann. § 56-7-109).
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