Leak 2: Underpayments

Payers owe you more.
Most never pay it.

11% of claims are paid below contract. ~90% of those variances are never disputed — because no one has time to check every payment against every payer contract.

Payer sends $847

Your contract says $923

Your EHR posts $847

The $76 difference disappears. At $25M revenue → $750K–$1.25M lost annually. Contingency pricing. Zero risk.

Start your free assessment Book a demo

HIPAA Compliant SOC 2 Certified Contingency — zero upfront

Underpayment Recovery Dashboard

Variances Found

2,847

+18% this month

Total Disputed

$412K

+$68K vs last mo

Recovered

$389K

94.4% success

Avg Variance

$76

per claim

Claim IDPaidOwedGapStatus

CLM-8821 $847 $923 -$76 Disputed

CLM-8819 $1,240 $1,380 -$140 Recovered

CLM-8815 $560 $620 -$60 Pending

CLM-8812 $2,100 $2,100 $0 Verified

Recovery by Payer

Anthem

82%

UHC

74%

Aetna

61%

Cigna

44%

By The Numbers

Zero upfront cost. Recovery starts in 30 days.

Contingency pricing — you pay only when we find and recover money.

100%

Of payments verified against contract

$100K+

Median first recovery per client

Upfront cost or monthly fee

97%

Collection success rate on identified variances

30 days

Average first recovery timeframe

The Silent Leakage Problem

11% of payments fall below contract.
Most organizations never notice.

Your billing team can’t manually verify every payment against 50+ payer contracts. Payers know this. The underpayment slips through.

3–5%

Of net revenue lost annually

Silently. No alarm goes off. Your EHR posts what the payer sends — not what your contract requires.

$847 vs $923

One claim. A $76 difference.

Multiplied across thousands of claims per month. Compounded across 50+ payer contracts with different rules.

$750K–$1.25M

Annual leakage at a $25M practice

High-complexity specialties — pain management, anesthesia, radiology — lose $2.75M+. The highest-risk segments.

11%

Revenue loss in specialty procedures

Pain management, anesthesia, and specialty procedures carry the highest underpayment risk of any care segment.

Zero

Tools in most practices that catch this

EHRs don’t. Billing staff can’t. Standard RCM software misses it. Your current stack has no underpayment detection layer.

~90%

Of underpayments never disputed

Because disputing requires time, contract knowledge, and follow-through. Three things payers are betting your team doesn’t have.

The math is clear. The solution is ANKA.

How ANKA Recovers It

Execution in five steps.
No meetings. No consultants. Just work.

Maps contracts

ANKA ingests every payer contract — fee schedules, modifier rules, allowed amounts, and billing code dependencies — everything that defines what you should be paid.

Compares payments

Every incoming payment is checked against the applicable contract. Did the payer pay the correct amount for this code, this modifier, this patient status, and this timeframe?

Identifies variances

When contracted amount doesn’t match payment received, ANKA flags the discrepancy, quantifies what you’re owed, and explains exactly why the payer underpaid.

Assembles documentation

ANKA pulls clinical evidence, contract language, and fee schedule excerpts and builds the recoupment case — without your team lifting a finger.

Submits & tracks

The submission goes to the payer. ANKA monitors the response, escalates if needed, and recovers the money. You see it posted. No follow-up required from your side.

FAQs

Underpayment Recovery

We accept fee schedules in any format: PDFs, Excel sheets, EDI 834 files, and direct payer API feeds. Our team ingests and maps them. You don’t build anything. The initial contract load typically takes 2–4 weeks, depending on the number of payers and the complexity of your billing structure.

We verify every flagged variance against the applicable contract, modifier rules, and patient eligibility at the time of service. False positives are rare because we are comparing exact payments against written contract terms. Our clients see a 97% collection success rate on identified variances — meaning payers agree and pay back what they owe.

First discovery: approximately 30 days into contract mapping. First recovery: typically 30–60 days after submission, depending on payer response time. Ongoing underpayments are flagged within 24 hours of payment posting.

No. You’re asking payers to honor their signed contracts. That’s not aggressive — that’s standard business practice. Our submission process is professional and documentation-driven, so payers can easily verify and pay. Many clients report that payers respect the formal, systematic approach. You’re not emotionally demanding; you’re contractually entitled.

The Full Picture

Underpayment recovery is step two.
Here is the complete execution layer.

Denial management

ANKA works every denied claim — reads the EOB, writes the appeal, files it, tracks outcomes, and reworks until recovered. Zero abandoned claims.

Learn about denial management

AR follow-up automation

Claims age during secondary follow-up. ANKA automates status checks, resubmissions, and escalations. Nothing ages out due to workload constraints.

Learn about AR automation

How it all works together

Denial management + underpayment recovery + AR follow-up = zero revenue leakage. One platform that fixes all three leaks simultaneously.

Full platform walkthrough

Payers owe you more.Most never pay it.