They pay less than your contract.
That money is owed to you today, and appeal windows keep closing. These are the issues we find most in specialty claims.
- Wrong fee schedule
Contract $139.00, paid $108.60 - Downcoded visit
Billed 99214, paid as 99213 - Procedure reduction misapplied
Primary 29881 paid at 50% - Incorrect bundling
2 procedures billed, 1 paid - Old rate after an increase
Raised Jan 1, old rate in March
Plus carve-outs, place-of-service downgrades, and payer-specific edge cases that only show up line by line.

