During Production

When contracts are in production, you can use the Account Worklist and Worklist Summary to find gross underpayments, and by viewing the details, you can determine whether to:

• Follow up with the payor to collect the full reimbursement.
• Identify trends of underpayments for specific service types.
• Re-negotiate better rates with the payor for specific service types.
• Call your FinThrive account representative to address any contract interpretation or data import/export issues.

Addressing underpayments with a payor can be a time-consuming and sometimes frustrating process. It takes time to reach payor representatives and convince them of underpayments. With Contract Manager, when you discover one underpayment, you can use the Account Worklist to identify all accounts with the same underpayment issue for that product or payor. For example, you can search for all accounts with a particular service type that appears to be habitually underpaid. Collectively, accounts with these service types might add up to significant amounts of underpaid revenue. Without the worklist query tool, these accounts could otherwise fall below the threshold for following up on suspected underpayments because, as single line items, the dollar amount seems insignificant.

If you find that a suspected underpayment appears to be higher than you would expect, you can look at the contract image, drill down to the contract terms and conditions in Contract Manager and look at the data on the UB. This will identify any possible sources of error, either because the contract terms were misinterpreted or data on the claim is in error or missing.

For more information about identifying and addressing data issues during production, refer to Processing Reports.