How do I know if an insurance payer underpaid a claim?

Compare the allowed amount on the 835 remittance with the contracted rate for that payer, code, clinician license and date of service. If the allowed amount is lower, the claim was underpaid. Owed does this for every line of every remittance.

What's the difference between the allowed amount and the contracted rate?

The contracted rate is what the payer agreed to pay. The allowed amount is what it actually recognized on the claim. They should match; when the allowed amount is lower, the difference is an underpayment.

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.

Why it happens

Payers load contracted rates into their claim systems by hand, per fee schedule and effective date. A schedule that was never updated, loaded under the wrong provider, or applied to the wrong date pays a little less on every claim, and nothing on the remittance says so.

How Owed checks

01
For every paid service line, Owed looks up your contracted rate for that payer, procedure code, the clinician's license tier, telehealth or in person, and the date of service, and multiplies it by the units.
02
It flags the line when the allowed amount is below that by more than $1 or 1%, whichever is larger, so rounding never becomes a finding.
03
Lines with other adjustments (denials, level-of-service reductions) are left to the findings made for them, so the same dollar is never counted twice.

What you'll see

The contracted rate, the fee schedule it came from and its effective date
The allowed amount and the difference
The clinician's license tier and whether the visit was telehealth
An appeal deadline: the payer's own window when you've recorded it, otherwise Owed's default (180 days for commercial plans, 120 for Medicare Advantage and 60 for Medicaid, from the payment date)

Rules decide, never AI: the same file always gives the same findings, and every finding shows its math.

What to do

Send the payer a payment reconsideration citing the fee schedule and its effective date. When the same variance repeats, ask provider relations to correct the schedule and reprocess every affected claim.

Questions

How do I know if an insurance payer underpaid a claim?: Compare the allowed amount on the 835 remittance with the contracted rate for that payer, code, clinician license and date of service. If the allowed amount is lower, the claim was underpaid. Owed does this for every line of every remittance.
What's the difference between the allowed amount and the contracted rate?: The contracted rate is what the payer agreed to pay. The allowed amount is what it actually recognized on the claim. They should match; when the allowed amount is lower, the difference is an underpayment.