Underpayment and denial recovery for independent practices
Insurers quietly underpay and deny claims your practice already earned. Clearia finds it in your remittance data, and gets it back. No upfront fee. Paid only from what we recover.
A claim paid under contract still posts as paid. No alert fires, so nobody looks.
Missing information, an authorization that was on file, a timely-filing dispute with proof. Correctable, rarely corrected.
Dispute rights run 90 to 180 days. Whatever nobody chased is gone for good.
We check every remittance line against your contracted rate, then match what we find against our library of insurer behaviors: the light fee schedule, the habitual downcode, the misapplied bundling edit, the authorization that was on file. One confirmed shortfall usually points to hundreds like it.
| Code | Paid as | Contract | Paid | Short |
|---|---|---|---|---|
| 29827 | 29827 | $1,412 | $1,180 | $232 |
| 99214 | 99213 | $142 | $98 | $44 |
| 20610 + 99213 | bundled | $168 | $0 | $168 |
| 23430 | denied CO-197 | $2,140 | $0 | $2,140 |
| 27447 | 27447 | $1,860 | $1,860 | $0 |
Which insurer, which codes, how much, and what's still inside the dispute window. You decide what we pursue.
We know which patterns each insurer reverses, and what it takes: the contract clause, the policy page, the proof. We pursue each pattern as one case through the insurer's own process, and the money lands in your account.
Measured at a real practice
An orthopedic practice in Miami. Hand and upper-extremity surgery, its own billing team, a typical mix of commercial and workers' comp insurers. We audited thirteen months of remittances, about 1,900 claims, line by line against contract. 30 percent of net insurance revenue had been paid short or denied for reasons that could have been fixed. That is 58 percent more than the practice had actually collected. The practice's own billers had done their job. The money was in the closed claims. Recovery is underway.
Getting paid on claims an insurer denied for a reason that can be fixed: missing information, an authorization that was on file, a timely-filing dispute you can prove. We build the corrected claim or the appeal, it goes back through the insurer's own process, and the money posts to your account. Clinical denials, where the insurer disputes medical necessity, are a different job and mostly not ours. Which denials are worth chasing, and which aren't.
Because their day is keeping new claims moving, and a denied or short-paid claim looks finished. Working one $180 shortfall takes an hour and never pays for itself. It only pays when someone finds the four hundred claims that share the pattern and pursues them together. No practice of 3 to 15 doctors staffs that job, and honestly it wouldn't make sense to. Why a short payment looks paid.
Nothing upfront. We work on contingency: our fee is a percentage of what actually arrives, set in the engagement letter, so we only do well when you do. The diagnostic is free either way, and if it finds nothing, you've confirmed from your own data that your insurers are paying your contracts. That's worth knowing.
No. We work from read-only access to your remittances under a signed business associate agreement. Once you approve the findings, we file the appeals and reconsiderations ourselves, as your authorized representative, through each insurer's own dispute process. Your billers keep their day. Insurers keep paying you exactly as they do today. We never receive or hold your money.
No. Nothing we do touches patients or patient balances. We work on the insurer side only, through the reconsideration and appeal processes your contracts already provide. We don't practice law.
Because we're a concierge firm. We work in the background for a small number of practices we choose carefully, and we grow by referral from the physicians we already work with. The free diagnostic is how we decide, together, whether yours should be one of them.
The same two or three people from the first call through the last dollar. No handoff to an offshore team, no ticket queue. Clearia, Inc. is a Florida corporation based in Miami.
Free diagnostic. About an hour of your team's time. No obligation.