Reconcile Payer Agreements Against Claims to Surface Underpayments

The problem

Health center billing teams submit claims to dozens of payers under negotiated rate schedules, but the actual payment received on any given encounter rarely matches the contract exactly—due to bundling rules, code modifiers, authorization gaps, or payer processing errors. Identifying the variance requires manually comparing remittance data against contract terms for each payer, a process that takes weeks per review cycle and misses recoverable revenue.

What this app does

An AI-powered payer intelligence and contract management app that reconciles remittance data against negotiated terms automatically. The app ingests payer contract PDFs, extracts the rate schedules and billing rules, and runs encounter-level claims through the contract engine to identify underpayments, denied patterns, and compliance gaps. The underpayment queue shows cases ranked by recovery potential with the specific contract clause and encounter record referenced.

Key takeaways

• AI extracts payer rate schedules and rules from contract PDFs automatically
• Encounter-level reconciliation flags underpayments with contract clause cited
• Underpayment queue ranked by recovery potential—no manual prioritization
• Payer performance trend visible without scheduling a manual audit

Who it's for

Billing directors, revenue cycle leaders, and compliance teams at Federally Qualified Health Centers, community health centers, and safety-net providers navigating complex multi-payer contract environments.

Find the underpayments before the audit finds them first

See how Domo can reconcile payer agreements against encounter claims and surface underpayments automatically. Request a tailored payer intelligence build.

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