What happens when an underpayment is identified?

Sarva flags the underpayment with the expected amount, actual paid amount, and the差异. It generates a dispute or appeal citing the contract rate. Staff review and approve the dispute before submission to the payer.

Can Sarva track underpayment trends over time?

Yes. Sarva tracks cumulative underpayment value by payer, which is valuable during contract renewal negotiations. If a payer consistently underpays by 3–5%, that data supports your case for contract correction or renegotiation.

Use Case

Healthcare Underpayment Identification with AI Contract Analysis

Underpayment identification compares each payment received from a payer against the contracted rate for that service, flagging instances where the payer paid less than the agreed amount. Sarva automates this comparison using your payer contracts, fee schedules, and 835 ERA data — identifying underpayments that manual posting would miss and initiating recovery workflows.

Identify Your Underpayments

The Business Problem

Payers routinely underpay claims — paying less than the contracted rate due to fee schedule errors, outdated pricing in their system, or improper application of modifiers. Manual payment posting does not catch underpayments because staff post what the payer sent, not what the payer owed. Over time, underpayments accumulate into significant revenue leakage that most practices never recover.

Affected Team

Billing, contracting, and revenue cycle leadership. Underpayment recovery requires contractual knowledge that most billing staff do not have. CFOs see the impact in lower-than-expected collection rates.

How It Works

Current Manual Workflow

Payments are posted based on the 835 ERA amount. No systematic comparison to the contracted rate occurs. Occasionally, a billing manager notices a payment that "looks low" and investigates. This is sporadic and relies on individual knowledge of contract terms. Most underpayments go unnoticed and unrecovered.

Automated Workflow with Sarva

Sarva compares each payment to the contracted rate for the specific CPT/HCPCS code, modifier combination, and payer contract. When the payment is less than expected, Sarva flags the underpayment, calculates the difference, and initiates a recovery workflow — generating a dispute or appeal with the contract rate cited as evidence.

Inputs

835 ERA payment data
Payer contract fee schedules
CPT/HCPCS code and modifier combinations
Payer-specific reimbursement rules

Outputs

Underpayment flags with amount差异
Contract rate comparison per payment
Recovery dispute generation
Underpayment trend analysis by payer
Cumulative underpayment value tracking

Human Oversight

Staff review flagged underpayments and approve dispute submissions. Sarva identifies the underpayment and generates the dispute, but staff confirm the contract terms before submission. Trend analysis helps contracting teams address systemic underpayment patterns during payer negotiations.

Security Considerations

All payment and contract data is encrypted and isolated. Contract terms are commercially sensitive and access-controlled. Full audit trails for every comparison and dispute. HIPAA BAA included.

Integration Considerations

Sarva ingests 835 ERAs and compares payments to contract rates loaded into the system. Contract fee schedules can be imported from spreadsheets or entered via API. The system supports multiple contract versions and effective dates for payers with tiered or updated fee schedules.

Limitations

Sarva can only compare payments against contracts that have been loaded into the system. If a contract has not been entered, underpayments for that payer will not be detected. Contract terms that are complex (tiered pricing, value-based adjustments) may require manual configuration. Some payers dispute underpayment claims and require extended negotiation.

Key Performance Indicators

Underpayments identified

Target

> 90% of contractual underpayments

Underpayment recovery rate

Target

> 60%

Cumulative underpayment value

Target

Tracked and reported

Payer underpayment trends

Target

Surfaced for contract negotiation

See how this workflow applies to your practice.

Identify Your Underpayments

Related Connectors

Calculating the True ROI of RCM Automation

Frequently Asked Questions

You load your payer contract fee schedules into Sarva — either by spreadsheet import or API. Sarva uses these rates to compare against actual payments. For practices with many contracts, Sarva's onboarding team assists with initial data entry.

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