Resolving a $10 Million Underpayment Challenge
About the Client
A regional health plan was engaged in a $10 million underpayment dispute with a nationwide healthcare institution covering multiple hospitals.
The challenge lies in resolving this financial dispute by accurately reconciling the claims data, addressing any potential payment errors, and ensuring a fair resolution that aligns with both parties’ contractual agreements.
Using our proprietary Intelligent Content Processing software, we performed a comprehensive claim analysis based on the contractually agreed-upon rates between the national facility and the health plan.
RESULTS
Despite the initial claims of a $10 million underpayment by the health plan, an in-depth analysis of the claims data uncovered a significant discrepancy. A closer examination proved that the true extent of the payment dispute resulted in a $4 million overpayment to the healthcare facility. A $14 million favorable impact to the health plan.
This analysis involved a detailed review of all relevant claims, comparing them against contractual agreements and payment terms. The findings highlighted errors in the initial calculations, prompting a reassessment of the financial reconciliation between the health plan and the healthcare facility, ultimately providing a more accurate picture of the financial situation.
$4 million
overpayment discovered
$14 million
favorable impact for the health plan
