Can I find underpayments without my fee schedule?

Partly: comparing each payment with what the same payer recently paid for the same code shows sudden drops. Loading your contracted rates catches the rest.

What should I do if a payer lowered its rates?

Look for a rate change notice. If none was sent, dispute the reduction and request the fee schedule in effect on the date 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.

Why it happens

Fee schedules change, sometimes with a notice that's easy to miss and sometimes by mistake. Without your contract loaded, the only sign is a smaller payment than last month's.

How Owed checks

01
Owed learns each payer's typical allowed amount per code, license tier and telehealth or in person from your remittances: the median over the preceding 180 days, from at least 5 paid lines.
02
It flags a line allowed below that by at least $2 and 3%. Once your contracted rates are loaded, contract underpayments take over for that payer.

What you'll see

The payer's typical rate, how many lines it's based on and the window
The allowed amount and the difference
An appeal deadline

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

What to do

Check for a fee schedule amendment or rate change notice from the payer. If there wasn't one, dispute the reduction and ask for the fee schedule in effect on the date of service.

Questions

Can I find underpayments without my fee schedule?: Partly: comparing each payment with what the same payer recently paid for the same code shows sudden drops. Loading your contracted rates catches the rest.
What should I do if a payer lowered its rates?: Look for a rate change notice. If none was sent, dispute the reduction and request the fee schedule in effect on the date of service.