Insurance underpayments. Found claim by claim.
Targeted review across payer contracts, payment methodologies, claim detail, and remittance data to identify underpayments that standard workflows and expected-payment models can miss.
Find underpayments hidden across payer methodologies.
GRT applies purpose-built, payer-specific analytics across hospital claim populations to identify potential underpayments based on contract terms and reimbursement methodologies. Experienced reimbursement auditors validate each finding and support recovery through the appropriate correction, appeal, or payer-resolution process.
Targeted detection. Expert validation.
Purpose-built, payer-specific analytics identify potential payment discrepancies. Experienced auditors validate findings and support recovery through the appropriate resolution path.
Apply targeted logic across claim populations.
Surface potential underpayment hits for review.
Auditors determine whether the claim was underpaid.
Paid does not always mean paid correctly.
Payer rules are highly specific
Contracts, reimbursement methodologies, payment policies, edits, and payer interpretations differ by plan and can change over time.
Paid claims fall out of the workflow
Once a claim reaches zero balance, there may be no natural reason to revisit it even when the payer paid less than the applicable contract or reimbursement methodology requires.
Expected-payment models cannot capture every scenario
Unusual code combinations, payer-specific policies, reimbursement exceptions, and specialty payment rules can fall outside even sophisticated expected-payment methodologies.
The answer may require multiple data sources
Determining whether a claim was paid correctly can require connecting account, claim, charge, transaction, remittance, and contract data rather than reviewing the final payment alone.
Opportunities can be highly targeted
Some underpayments only emerge when specific payer, contract, coding, charge, or clinical combinations are tested against the payment actually received.
Identification is only half the work
Recovery may still require documentation, claim correction, appeal, payer follow-up, or another resolution path before the hospital receives the additional reimbursement.