# Owed: product and security reference > Find payment gaps in your behavioral-health remittances, review the evidence, prepare supported appeals and track recoveries with Owed. Owed is revenue recovery software for behavioral-health practices and their billing companies, starting in Tennessee. It checks 835 remittances for payment gaps using contracted rates, payment history, reason codes and applicable payer and state rules. Findings identify estimates and unconfirmed rules. Owed supports contract fee-schedule review, nightly SFTP imports, multiple practices, template-based appeal letters, appeal follow-ups and recovery matching from later remittances. Practices review and send appeals themselves; a finding or payer acceptance does not guarantee recovery. Detection is deterministic; Claude on Amazon Bedrock only transcribes contract rates for human review. Owed currently works with synthetic data only. Its AWS BAA is active, and a customer BAA plus the remaining compliance and security reviews are required before live patient data. # Security and compliance Source: https://owed.health/security Information updated: 2026-10-02 ## Current status Owed currently works with synthetic data only. We are not accepting live patient data while we complete counsel review, policy approval, workforce training, an incident-response exercise and an independent security review. Remittances marked as production are rejected. Our AWS business associate agreement is active. Customer agreements must be signed before any patient data is accepted. The controls below describe the customer application. Our public demo runs separately with fictional records and supplied sample files. Its anonymous workspaces expire after 30 minutes; it does not send appeals, deliver real invitations or connect to outside SFTP servers. The demo is not an environment for patient data. ## Agreement before data A signed business associate agreement (BAA) is required with each customer before any protected health information (PHI) is shared. When the customer is a billing company, Owed acts as its subcontractor business associate. We must verify that the customer's agreements with its practices permit the service and disclosure to Owed, including any required subcontractor approval. For programs covered by 42 CFR Part 2, the applicable agreement terms are also subject to counsel review before onboarding. Our development and test systems refuse remittances marked as production. Our infrastructure runs on Amazon Web Services and is covered by the AWS Business Associate Addendum. Every AWS service that stores or processes patient data is on AWS's list of [HIPAA-eligible services](https://aws.amazon.com/compliance/hipaa-eligible-services-reference/). Eligibility and an AWS BAA do not by themselves establish Owed's HIPAA compliance. ## Encryption - In transit: TLS 1.2 or newer with modern ciphers, HTTPS enforced with HSTS, and verified TLS between the application and the database. - At rest: the database, backups, secrets, application logs and audit trail use an AWS KMS key that Owed controls and rotates yearly. Other service logs are encrypted at rest. - In the application: patient names, member IDs, patient control numbers and the raw remittance files are encrypted again with AES-256-GCM before they reach the database. Those fields remain encrypted in a database-only copy. - Automatic imports: SFTP connection details and credentials are field-encrypted too. Owed checks the server's pinned SSH key before reading files and leaves the source files in place. Saved credentials are never returned to the browser or included in exports or logs. ## Access - Every customer user signs in with a password and a time-based authenticator code. There is no way to turn multi-factor authentication off. - Accounts are created only by invitation from an owner or admin, each for a named person. There are no shared logins. - Roles (owner, admin, biller, viewer) limit what each person can see and do, and are checked on every request. - Sessions end after 15 minutes idle and 12 hours in total. Five wrong passwords lock the account for 15 minutes. - Patient identifiers are masked by default; revealing one is a deliberate action that is recorded. ## Isolation Each customer's data is separated inside the database by row-level security. The application reaches customer data through a restricted database role, with policies that limit queries to the active organization. These controls add a database-level check alongside application permissions. ## Audit trail An append-only audit log records every view of patient data, every reveal of an identifier, every export and every change: who, what and when. Entries are chained with cryptographic hashes and protected by database triggers, so they can't be edited or removed without detection. The log itself never contains patient information. Separately, the customer environment records AWS management API activity through CloudTrail in write-once storage that no one, including us, can delete for six years. ## Minimum necessary Owed asks only for the data it needs to find what payers owe. Reports leave out patient names and member IDs and truncate claim numbers, and each one is recorded with an ID printed on every page. The one exception is the complete export an owner can take of their own data, for example when leaving; it's recorded the same way. Our application logs never contain request bodies, remittance content or decrypted fields. ## Infrastructure - The application and database run in AWS US East, Ohio, in a production account dedicated to customer data. Contract reading uses Amazon Bedrock across US regions only. - A web application firewall in front of the application, and continuous threat detection across the account. - Point-in-time database recovery for 35 days, with deletion protection, plus daily copies retained for 30 days using AWS Backup Vault Lock. We've tested a full restore. - Even our own administrators can't turn off audit logging or threat detection, or delete encryption keys, secrets or backups, without a separate emergency procedure that is itself logged. - Infrastructure defined as code; container images are scanned for vulnerabilities, and a deploy stops on any critical finding. ## AI Claude Sonnet 4.6 on Amazon Bedrock reads fee schedules from contract PDFs through a US-only inference profile. Every rate goes through checks and then your review before it is saved. Contract uploads must not contain patient information. Payment findings use deterministic rules, and supported appeal letters come from fixed templates. You review and send the letters yourself. Contract PDFs and reader results are held temporarily in application memory. Bedrock's [data-protection documentation](https://docs.aws.amazon.com/bedrock/latest/userguide/data-protection.html) describes model processing; Owed does not use customer data to train models. ## Our commitments before real PHI Our risk analysis and security, privacy and incident-response policies are drafted and awaiting review and approval. Before live PHI, we must finish those reviews, train everyone with production access, exercise incident response, complete an independent security review and move incoming business email to a BAA-covered mailbox. We do not hold a SOC 2 report. [HHS does not recognize private HIPAA certifications](https://www.hhs.gov/hipaa/for-professionals/faq/are-we-required-to-certify-our-organizations-compliance-with-the-standards/index.html) as proof of compliance. ## Reporting a vulnerability If you believe you've found a security issue, email [security@owed.health](mailto:security@owed.health). We respond promptly and won't pursue good-faith research that avoids privacy violations and service disruption. Our [security.txt](https://owed.health/.well-known/security.txt) has the details. # Policies - [Privacy policy](https://owed.health/privacy) - [Terms of service](https://owed.health/terms) # What Owed finds ## Paid less than agreed ### Contract underpayments Source: https://owed.health/findings/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: - 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. - 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. - 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 each finding shows: - 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: your window for the payer when you've set one; otherwise the one the payer publishes, where Owed has checked it against the payer's own documents (BlueCross BlueShield of Tennessee, 18 months; Cigna Healthcare, 180 days); otherwise Owed's default (180 days for commercial plans, 60 for confirmed Medicare Advantage plans, 60 for Medicare-type claims (filing codes MA, MB and 16) and 60 for Medicaid, from the remittance's date); with Tennessee's 15-month payment-correction date shown separately as an outer limit (Tenn. Code Ann. § 56-7-110(b)) on plans you've confirmed are fully insured. Pending legal review, Owed keeps the payer's applicable deadline 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. Q: How do I know if an insurance payer underpaid a claim? A: 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 may have been underpaid, subject to contract terms such as lesser-of-charge. Owed does this for every line of every remittance. Q: How long do I have to dispute an underpayment in Tennessee? A: On fully insured plans, Tennessee law says an insurer isn't required to correct a payment error when the provider asks more than 15 months after receiving payment (Tenn. Code Ann. § 56-7-110(b)), and the section can't be waived by contract. Pending legal review, Owed keeps the payer's applicable deadline and shows the 15-month date separately as an outer limit. Q: What's the difference between the allowed amount and the contracted rate? A: The contracted rate is what the payer agreed to pay. The allowed amount is what it actually recognized on the claim. When the allowed amount is lower, the difference may be owed, subject to contract terms such as lesser-of-charge. ### Paid at the wrong license tier Source: https://owed.health/findings/license-tier-underpayments 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. Why it happens: Many payers pay psychotherapy codes at different rates for doctoral clinicians (PhD, PsyD, MD, DO), nurse practitioners and master's-level therapists (LCSW, LPC, LMFT). If a clinician is enrolled at the wrong level, every claim they bill is paid at the lower rate until someone notices. How Owed checks: - Owed knows each clinician's license tier from your roster. For a doctoral or NP clinician's paid line, it compares the allowed amount with their own tier's contracted rate. - When the line is short by more than $1 or 1%, whichever is larger and the allowed amount matches a lower tier's rate, it's flagged. The lower rate comes from your fee schedule, or, when you haven't loaded one, from typical tier ratios (nurse practitioners at 85% and master's-level clinicians at 75% of the doctoral rate). What each finding shows: - The clinician's tier and the tier they were paid as - The rate they should have been paid and the allowed amount - An appeal deadline, with Tennessee's 15-month payment-correction date shown separately as an outer limit (Tenn. Code Ann. § 56-7-110(b)) on plans you've confirmed are fully insured. Pending legal review, Owed keeps the payer's applicable deadline What to do: Check the clinician's credentialing and enrollment record with the payer and ask for the license level to be corrected, then request reprocessing of the affected claims within the corrected-claim window. Q: Why is my psychologist being paid the same as a master's-level therapist? A: One possible cause is enrollment at the wrong license level. Check the clinician's enrollment and your fee schedule, then request correction and reprocessing where the contract supports a higher rate. Q: Do insurers pay different rates by clinician license? A: Many do: doctoral clinicians, nurse practitioners and master's-level therapists often have separate rates for the same psychotherapy code in the same contract. Q: How long do I have to dispute an underpayment in Tennessee? A: On fully insured plans, Tennessee law says an insurer isn't required to correct a payment error when the provider asks more than 15 months after receiving payment (Tenn. Code Ann. § 56-7-110(b)), and the section can't be waived by contract. Pending legal review, Owed keeps the payer's applicable deadline and shows the 15-month date separately as an outer limit. ### Downcoding Source: https://owed.health/findings/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. Why it happens: Some payers run automated reviews that swap a billed code for a lower-paying one, or trim payment for level of service, often without a clear notice beyond a code on the remittance. How Owed checks: - The 835 shows the code you submitted when the payer paid a different one. Owed values the line at your contracted rate for the code you billed (or, without a contract, the payer's typical rate for it) and flags the difference when it's more than the tolerance. - It also flags reductions the payer made for level of service or frequency (adjustment reason codes 150, 151). What each finding shows: - The code billed and the code paid - What the billed code should have paid, and what was allowed - Whether that figure came from your contract, the payer's typical rate or the reduction itself - An appeal deadline What to do: Appeal with documentation that supports the billed level of service, including the session's start and stop times from the progress note. Q: What is downcoding in medical billing? A: It's when a payer processes a claim as a lower-level code than the provider billed, or reduces payment for level of service, which lowers what it pays. Q: How do I appeal a downcoded psychotherapy claim? A: Request reconsideration with documentation supporting the billed code, especially session start and stop times, and cite the payment you expected under your contract. ### Rate drops Source: https://owed.health/findings/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: - 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. - 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 each finding shows: - The payer's typical rate, how many lines it's based on and the window - The allowed amount and the difference - An appeal deadline 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. Q: Can I find underpayments without my fee schedule? A: 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. Q: What should I do if a payer lowered its rates? A: 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. ### Telehealth paid less Source: https://owed.health/findings/telehealth-underpayments A telehealth gap is a telehealth service paid below the same payer's in-person rate for the same code and clinician tier. Why it happens: Some payers pay telehealth visits less than office visits. Tennessee has coverage and reimbursement protections for encounters meeting its statutory telehealth or provider-based telemedicine definitions (Tenn. Code Ann. §§ 56-7-1002, 56-7-1003, 56-7-1012). Check the encounter, plan and provider agreement before deciding whether a lower rate is allowed. How Owed checks: - Owed recognizes telehealth lines by their modifiers (95, GT, GQ, FQ, 93). - For commercial claims with no contracted rate on file, it compares the allowed amount with the payer's typical in-person rate for the same code and tier over the preceding 180 days, and flags gaps of at least $2 and 3%. - The comparison is a review flag. An 835 telehealth modifier alone doesn't establish that the encounter meets Tennessee's statutory definitions or prove the rate the law requires. - Tennessee's telehealth sections include TennCare managed care organizations and the state and local government plans authorized under title 8, chapter 27. They don't apply to plans governed by ERISA or to grandfathered plans, and Medicare follows federal rules. Owed runs this check on commercial claims only, including self-funded claims, as a payment-gap review flag. What each finding shows: - The in-person typical rate and how many lines it's based on - The telehealth allowed amount and the difference What to do: Check the encounter's statutory eligibility, plan and telehealth terms of your provider agreement. Ask the payer which term or reimbursement rule supports the lower rate, and have the legal basis reviewed before appealing. Q: Does Tennessee require telehealth payment parity? A: Tennessee's reimbursement protections remain in effect: 2022 Public Chapter 766 removed the April 2022 sunset. Section 56-7-1012 requires reimbursement consistent with the policy or contract's in-person terms for encounters meeting the statutory telehealth or provider-based telemedicine definitions. The required rate and applicability to an encounter or plan need contract and legal review; an 835 modifier alone doesn't resolve them. Q: How can I tell if telehealth is being paid less? A: Compare what each payer allows for a telehealth visit with what it allows for the same code in person. Owed does this automatically from your remittances. ## Not paid at all ### Recoverable denials Source: https://owed.health/findings/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. Why it happens: Reason codes can be hard to interpret, and missed deadlines can prevent a correction or appeal. Owed groups denials by the action their reason codes suggest, while keeping low-confidence cases visible for review. How Owed checks: - Owed groups denied lines by claim and reads the claim adjustment reason code (CARC) on each. - It sorts the denial by what usually resolves it: correct and resubmit (for example CARC 16, missing information), verify (duplicates and coordination of benefits), credentialing (the provider isn't eligible with the payer), appeal (medical necessity, authorization, timely filing), or the patient's coverage (ended, or not a covered benefit), which is rarely recoverable, so it ranks low. - It values the claim at what the lines should have paid: your contracted rate, the payer's typical rate, or a conservative share of the charge. - Denials handled by more specific findings (wrong payer, add-on codes) are left to them. What each finding shows: - The group and reason code, in words - What the claim should have paid and how that was worked out - How the denial is usually resolved - An appeal deadline What to do: Correct and resubmit claims denied for billing or data errors. Appeal coverage and medical-necessity denials with documentation, within the payer's appeal window. Q: Which denied claims should a practice work first? A: The ones most likely to be paid for the least effort: billing and data errors you can correct and resubmit, then appeals with strong documentation, sorted by value and deadline. Q: What is a CARC code? A: A claim adjustment reason code: the standard code on a remittance that explains why a payment differs from the amount billed, including why a claim was denied. ### Wrong-payer denials Source: https://owed.health/findings/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. Why it happens: Many health plans carve out behavioral health to a separate administrator. Claims sent to the medical plan come back denied, and the practice has a limited time to send them to the right one. How Owed checks: - Owed finds lines denied with CARC 109 (claim not covered by this payer) and totals what they should have paid. - It sets a deadline 90 days from the date of service, a conservative default for resubmitting to the right payer before its filing limit. What each finding shows: - The denied lines and what they should have paid - The resubmission deadline What to do: Verify eligibility and coordination of benefits, then submit the claim to the responsible payer or behavioral-health administrator before its timely filing limit. Q: What does denial code CARC 109 mean? A: The claim or service isn't covered by this payer; it should be sent to the correct payer or administrator, often a behavioral-health carve-out. Q: What is a behavioral health carve-out? A: An arrangement where a health plan hands its mental health and substance use benefits to a separate company, which then processes those claims. ### Add-on code denials Source: https://owed.health/findings/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. Why it happens: Add-on codes are billed only together with a primary service. Payer edits often deny them when a modifier is missing or when they're processed apart from the primary code. How Owed checks: - Owed watches the behavioral-health add-on codes 90785, 90840, 90833, 90836, 90838. - When one is denied with reason code 97, 4 (included in another service's payment, or a modifier problem) while the primary service on the same claim was paid, it's flagged and valued at what the add-on should have paid. What each finding shows: - The add-on code and the denial reason - What it should have paid - An appeal deadline What to do: Confirm the primary and add-on codes were on the same claim with the required modifiers and documentation, then submit a corrected claim or appeal. Q: Why was my add-on code denied as bundled? A: Usually because it wasn't billed on the same claim as its primary code, a required modifier was missing, or the payer's edit treated it as included in the primary service. ## Taken back or paid late ### Recoupments Source: https://owed.health/findings/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. Why it happens: Offsets usually appear as provider-level adjustments at the bottom of a remittance; some payers show them as negative claim lines instead, so they're easy to miss. Tennessee generally limits recoupment to 15 months after payment, or 18 months for state employee health plans (Tenn. Code Ann. § 56-7-110). Where the payer or its eligibility agent verified coverage and you provided services in reliance on that verification, the limit for recouping because the patient wasn't covered is six months from payment (§ 56-7-110(d)). Fraud, suspected fraud, agreed tolling and plan-specific exclusions can affect the rule. How Owed checks: - Owed flags provider-level adjustments WO, FB, WU, 72, J1 with positive amounts (reductions in the payment) for review. Of these, only WO denotes overpayment recovery; FB is a balance forward, WU is a federal levy, 72 acknowledges a refund you sent, and J1 is a non-reimbursable amount. - Where the payer references the original claim, it finds that claim's payment and works out how long ago it was paid. - For Tennessee claims where commercial state law may apply, it flags offsets beyond the longer 18-month limit for review. The remittance doesn't identify state employee plans, so it doesn't label an offset between 15 and 18 months as barred. - The 30-day period to appeal and stop withholding starts on the notice date, which must generally precede the offset by 30 days. An 835 doesn't establish the notice date, so Owed leaves this statutory deadline unset and asks you to check the notice immediately. - You tell Owed how each payer's plans are funded. It still flags recoupments from payers you've marked self-funded, Medicare or Medicaid, without the Tennessee statute and with a 60-day default deadline from the payment date on the remittance. For eligible Tennessee claims, it marks the rule as confirmed when you've confirmed a payer is fully insured, or unconfirmed when funding is unknown. What each finding shows: - The amount taken and the reason code - The original claim's payment date and how many months ago it was, when the payer says which claim - The statute, when it applies - A notice-date review warning when the statutory deadline can't be determined What to do: Get the payer's overpayment notice immediately and check its date, basis, amount and appeal instructions. A payer can't base a recoupment on extrapolation from an audit (§ 56-7-110(m)). Confirm the plan and any fraud or tolling exception before relying on a statutory limit. Q: What is a recoupment in medical billing? A: It's when a payer recovers money it says it overpaid by withholding it from a later payment. It usually shows up as a provider-level adjustment (PLB) on the 835 remittance; some payers show it as negative claim lines instead. Q: How far back can an insurer recoup payments in Tennessee? A: Tennessee generally limits recoupment to 15 months after payment, or 18 months for state employee health plans (Tenn. Code Ann. § 56-7-110). Where the payer or its eligibility agent verified coverage and you provided services in reliance on that verification, the limit for recouping because the patient wasn't covered is six months from payment (§ 56-7-110(d)). Fraud, suspected fraud, separate agreed tolling and exclusions such as TennCare products require review. The 30-day period to appeal and stop withholding runs from the notice date, not the later offset. ### Prompt-pay interest Source: https://owed.health/findings/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). Why it happens: Missing interest can be easy to overlook when reviewing individual payments. Owed totals eligible shortfalls by remittance so you can review one interest request per payment. How Owed checks: - For commercial claims, Owed reads the date the payer received each claim and the date it paid it, and skips claims submitted more than 90 days after the service. - If payment came more than 21 days after receipt, it computes interest at 1% a month for the days late, minus any interest the payer already paid. - A late payment alone doesn't prove the claim was clean; the payer may have sent a not-clean notice within 21 days. Check any notice against § 56-7-109(b)(1)(B)(iii). - Because interest per claim is small, it totals the interest per payment, so there's one request per remittance instead of dozens. - This statute doesn't apply to self-funded ERISA plans, Medicare or TennCare, which has its own rule (§ 56-32-126). You tell Owed how each payer's plans are funded: it leaves the finding out for payers you've marked self-funded or government, says so when you've confirmed a payer is fully insured, and marks it unconfirmed otherwise. What each finding shows: - How many claims were late and the longest delay - The interest owed and the statute What to do: Ask the payer for the statutory interest, citing the prompt-pay statute, the claim receipt dates and the payment date. Q: How long does an insurer have to pay a clean claim in Tennessee? A: 21 days for clean claims submitted electronically, under Tennessee's prompt-pay law (Tenn. Code Ann. § 56-7-109). Late payments owe interest at 1% a month. Q: Do prompt-pay laws apply to every plan? A: No. Tennessee's § 56-7-109 doesn't apply to self-funded ERISA plans, Medicare or TennCare, which has its own rule (§ 56-32-126). Owed leaves these findings out for payers you've marked self-funded or government, and marks them unconfirmed until you confirm a payer's plans are fully insured. # Glossary Source: https://owed.health/glossary - **835** (ERA, electronic remittance advice): The HIPAA-standard electronic file (ASC X12 835) a payer sends with a payment. It lists every claim and service line paid or denied, the amounts billed, allowed and paid, and the adjustment codes that explain each difference. - **837** (electronic claim): The HIPAA-standard electronic claim a provider sends to a payer. Therapy and other professional services use the 837P. - **Allowed amount**: The most a payer recognizes for a service under the provider's contract or the plan's fee schedule. The payer's payment plus the patient's share (copay, coinsurance, deductible) should add up to it. - **Contracted rate** (fee schedule): The amount a payer agreed to pay for a procedure code, set out in a fee schedule that can vary by clinician license level, telehealth or in person, and effective date. - **Underpayment**: A claim line allowed for less than the contracted rate for that payer, code, clinician and date of service. The difference may be owed to the provider, subject to contract terms such as lesser-of-charge. - **CARC** (claim adjustment reason code): A standard code on a remittance explaining why a payment differs from the amount billed, such as 45 (charge exceeds the fee schedule), 16 (missing information) or 109 (not covered by this payer). - **RARC** (remittance advice remark code): A supplemental code that adds detail to a claim adjustment reason code, such as which piece of information was missing. - **Group code**: The two letters before an adjustment reason code that say who bears the adjustment: CO (contractual obligation, written off by the provider), PR (patient responsibility), OA (other adjustment) or PI (payer-initiated reduction). - **Contractual adjustment**: The difference between the billed charge and the allowed amount under the contract, usually reported as CO-45. The provider writes it off; it isn't billed to the patient. - **Denial**: A claim or service line the payer paid nothing on, with an adjustment reason code saying why. Many denials can be corrected and resubmitted or appealed. - **Downcoding**: When a payer processes a claim as a lower-level procedure code than the one billed, or reduces payment because it says the documentation doesn't support the level of service. - **Credential tier** (license tier, licensure level): The license level a payer pays a clinician at. Many contracts pay doctoral clinicians (PhD, PsyD, MD, DO), nurse practitioners and master's-level therapists (LCSW, LPC, LMFT) different rates for the same code. - **Add-on code**: A procedure code billed only together with a primary service code on the same claim, never on its own. Behavioral-health examples include 90785 and 90840. - **Recoupment** (payment offset, clawback): Money a payer takes back for what it says was an overpayment, by withholding it from a later payment. It usually shows up as a provider-level adjustment (PLB) on the 835; some payers show it as negative claim lines instead. - **PLB** (provider-level adjustment): The part of an 835 for amounts not tied to one claim, such as recoupments, interest and forwarded balances. - **Prompt-pay law**: A state law requiring insurers to pay clean claims by a deadline, with interest when they're 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). - **Clean claim**: A claim with no defect and all the information the payer needs to process it. Prompt-pay deadlines apply to clean claims; the exact definition comes from state law. - **Timely filing limit**: The deadline for submitting a claim after the date of service, set by the payer contract or plan. Claims filed late are denied, often with CARC 29. - **Appeal** (reconsideration): A request that the payer review and reprocess a claim it denied or underpaid, with the evidence. Appeal windows differ by payer and plan type and run from the payment or denial date. - **Coordination of benefits** (COB): The rules deciding which plan pays first when a patient has more than one. Errors cause denials such as CARC 22 (another payer may cover it) or 109 (not covered by this payer). - **Behavioral health carve-out**: An arrangement where a health plan hands its mental health and substance use benefits to a separate company, which processes those claims. Claims sent to the medical plan instead are denied. - **Telehealth modifier**: A modifier on a claim line marking the service as telehealth: 95, GT, GQ, FQ, 93. Place of service codes 02 and 10 also mark telehealth. - **Telehealth payment parity**: A requirement to reimburse telehealth at the same rate as the same service in person. Tennessee's active reimbursement provision, section 56-7-1012, requires consistency with in-person policy or contract terms for encounters meeting the statutory telehealth or provider-based telemedicine definitions (Tenn. Code Ann. §§ 56-7-1002, 56-7-1003, 56-7-1012). 2022 Public Chapter 766 removed its April 2022 sunset. The required rate and encounter or plan eligibility need legal review. - **Fully insured plan**: A health plan where an insurance company takes on the risk of paying claims, in exchange for premiums. State insurance laws, including prompt-pay, recoupment and telehealth parity laws, generally apply to it; federal employee plans are an exception because federal contract terms can preempt state law. - **Self-funded plan**: An employer health plan that pays claims from the employer's own funds, usually through an insurer acting as administrator. Private employer plans are generally governed by federal ERISA rules and outside most state insurance laws, including prompt-pay laws. Government and church plans can be self-funded and are generally outside ERISA. - **Business associate agreement** (BAA): A HIPAA contract between a practice (a covered entity) and a vendor, or a billing company and its subcontractor, for handling protected health information. It requires the recipient to protect that information and use it only for the agreed service. - **Protected health information** (PHI): Individually identifiable health information held by a covered entity or its business associates, such as a patient's name with the services they received. Remittances contain it. - **42 CFR Part 2**: The federal rule that adds protection to substance use disorder treatment records from federally assisted programs, limiting how they may be disclosed and used. # Frequently asked questions Q: Can Owed import remittances automatically? A: Yes. Connect a practice's SFTP folder, a secure file-transfer connection, and Owed reads new 835 files each night. Setup requires your provider's login and verified server fingerprint. Imports use the same checks as uploads, skip duplicates and leave the provider's files in place. You can pause imports or run one manually. Q: What is Owed? A: Revenue recovery software for behavioral-health practices and billing companies. Owed checks 835 remittances for payment gaps, ranks findings with their evidence, drafts supported appeal letters and matches later payments to track recoveries. Q: What is an 835 (ERA) file? A: The electronic remittance advice payers send with each payment: every claim line, what was allowed and paid, and the reason codes for any difference. Your clearinghouse or billing system can export them. Q: How does Owed find underpayments? A: Owed compares allowed amounts with the contracted rates you have loaded. Where applicable, it also uses your own payment history and flags denials, recoupments, missed prompt-pay interest and rate drops. Findings identify estimates and unconfirmed rules; a flag is not a guarantee of payment. Q: How do I add my contracted rates? A: Upload a contract PDF and Owed lists the rates for you to review. You can leave out any row, and nothing is saved until you confirm. Saving re-checks your findings against the new rates. You can also import a fee schedule as a CSV. Contract uploads must not contain patient information. Q: Does Owed notice when a payer pays what it owed? A: Yes. Every new 835 is matched to your findings. When a payer reprocesses a claim, pays a denied service, returns a recoupment or adds the missing interest, Owed records what came in and marks the finding recovered once it's covered, showing the payment it arrived in. Q: Does Owed use AI to decide what's owed? A: No. Detection uses deterministic rules applied to your remittances, rates, payer settings and payment history. Claude on Amazon Bedrock reads contract fee schedules for your review; it does not decide findings or write appeal letters. Q: Is Owed HIPAA compliant? A: Owed currently works with synthetic data only while we complete the remaining compliance and security reviews. Encryption, mandatory MFA, organization isolation and audited patient-data access are built in, and our AWS BAA is active. A signed customer BAA and the remaining launch checks are required before live PHI. We do not hold a SOC 2 report or claim HIPAA certification. Q: Can Owed draft and track appeals? A: Yes. Owed drafts template-based letters for 5 finding types: underpaid, downcoded, telehealth paid less, recoupment, interest owed. You review, approve and send the letter yourself, then record submissions, follow-ups and payer responses. Approval and payer acceptance do not count as recovered money; later remittances establish the recovery. Q: Can I manage more than one practice? A: Yes. One organization can manage multiple practices, with separate remittances, rates and SFTP connections. Switch between a practice and All practices to scope findings, follow-ups, recovery totals and scan reports. Practice selection is a filter; organization roles govern access. Q: Who is Owed for? A: Behavioral-health group practices that bill insurance directly, and the billing companies that serve them. We're starting in Tennessee. Q: How much does Owed cost? A: Owed is priced around what it recovers for you. We walk through it on a call. Owed never receives or holds your insurance payments; payers pay your practice directly.