Clearia.
contact@cleariagroup.comUnderpayment recovery for independent specialty practices
Your payer contracts say one number; the payments say another. The gap — a downcoded procedure here, an underpaid code there — closes at a zero balance, looking paid, so you never see it. Clearia finds it, shows it to you in dollars, and recovers it. No upfront fee, no software, no change to how you bill. We're paid only from what we actually recover.
Industry analyses put commercial-payer underpayment at 1 to 3 percent of net revenue — and that's the average across all providers, including hospital systems with entire teams watching for it. Independent practices, where nobody watches, sit at the exposed end of that range. We've seen what checking actually turns up: one $20M independent practice ran the audit on its own data — with us in the room — and found 6 percent.
And notice what kind of money it is: pure margin. Recovered underpayment has no cost attached — no staff time to earn it, no supplies, no overhead. The care was already delivered. At typical practice margins, even the conservative end of the range equals a tenth of your profit. At six percent, it can be a third.
It survives because nothing flags it:
Each claim closes at zero balance. No alert fires. And payer dispute windows run out in 90 to 180 days — what stays unnoticed long enough becomes unrecoverable, permanently.
This is not a gap in your team's work. A biller's job is keeping claims moving — and payer-side shortfalls are built to look like finished business. Catching them means checking every remittance line against the contracted rate for that code, payer by payer, on claims that show nothing owed.
No practice of 3 to 15 physicians staffs that job. And chasing a single $180 shortfall never pays for the hour it takes — it only becomes worth doing when someone finds the four hundred claims that follow the same pattern and pursues them as one case. That is the job we built Clearia to do.
Here's what makes recovery possible: underpayment isn't random — it's systematic. Payers run on rules, and the same quiet rule fires the same way across thousands of claims: a bundling edit applied where your contract says it shouldn't be, a fee schedule loaded a few percent light, a procedure downcoded on the same pretext, month after month. Each payer has signature behaviors. We study them for a living.
That's why we don't just compare payments to contracts — we recognize the patterns behind the shortfalls, and we know which ones payers reverse when challenged correctly. Payers count on no one looking closely enough to see the pattern; when someone does, their own reconsideration process becomes the instrument that pays you back. We use their rules, their process, and their paper trail — better than they expect anyone to.
If we find nothing, you've spent an hour and paid nothing — and you'll know, from your own payment records, that your payers are paying your contracts correctly. That answer is worth having.
If we find money, you pay only out of dollars that actually arrive. No retainer, no hourly fees, no invoice to gamble on. We carry the risk of being wrong — which is exactly why we won't take an engagement unless the diagnostic shows real recoverable dollars. Our incentives and yours point the same direction: worst case, you get a free expert read of your payment data.
For: independent, procedure-heavy specialty practices — orthopedics, spine, sports medicine, pain management, ENT, gastroenterology, dermatology, cardiology, and their peers — typically 3 to 15 physicians, running without a revenue-cycle department. Ambulatory surgery centers too: ASC claims carry exactly the kind of complexity where underpayment hides.
Not for: hospitals and health systems with revenue-cycle teams (good vendors already serve them), or practices looking to outsource billing — we don't do billing. We do one job: find what payers underpaid, and get it back.
You'll be the one who makes this work, so here's your part in full: about an hour, once — setting up read-only access to payment reports and sharing the payer contracts, with us beside you. No software to install, no new system for your staff, no interruption to billing or posting. And nothing here audits your team's work: underpayment sits on the payer's side of the ledger.
After that hour, work comes off your plate — not onto it. The appeals and payer follow-up you currently squeeze in between everything else — pulling documentation, drafting reconsideration letters, chasing payer responses for months — that work is inside our scope. We build the case files, draft the appeals, and track every payer response to the end; your team sends them out under the practice's name and stays in control. The disputes you never had time to fight finally get fought — and not by you. If you're reading this before your physicians are, this page is written to be forwarded.
Nothing upfront, ever. The diagnostic is free, and our fee is a percentage of dollars actually recovered. If we recover nothing, you owe nothing.
No — it's arithmetic. Your payer contracts specify a rate for every code. Your remittances record what was actually paid. We compare the two, line by line — and because underpayment follows payer-specific patterns, one confirmed shortfall usually points to hundreds more like it. We pursue them through each payer's own reconsideration process. The money exists because, in most practices, nobody has ever looked.
Every engagement starts with a signed business associate agreement before any data moves. Access is read-only, limited to payment records, and data travels only through HIPAA-covered channels.
About an hour, once. Your administrator sets up read-only access to payment reports and shares your payer contracts — we walk through it together. After that we work independently.
No. Underpayment reconsiderations are a routine, contractual process that payers handle every day. We use the dispute mechanisms your contracts already provide, professionally and by the book.
No. We never touch claim submission, posting, or your billing workflow. Underpayment sits on the payer's side of the ledger — finding it is a different job from billing, and we only do that job. If anything, work moves off your team's plate: the underpayment appeals and payer follow-up your staff currently handles between everything else become ours to prepare, manage, and see through.
Then you've verified — from your own payment records — that your payers are paying your contracts correctly, and it cost you nothing. That answer has value too.
The diagnostic takes weeks, not months, once we have access to your remittances and contracts. Recoveries then follow each payer's reconsideration timelines. One constraint is real: payer dispute windows typically run 90 to 180 days, so older claims age out permanently.
The diagnostic answers the only question that matters — in dollars, from your own payment records.
No cost, no obligation, about an hour of your team's time.