Underpayment Recovery & Contract Variance
Underpayment Recovery & Contract Variance from Soft Home Global costs $1,900 per seat per month. That is one full time trained person, forty hours a week, working United States business hours inside your own system. One seat, one month, cancel any time.
A claim that pays is assumed to have paid correctly. Often it has not — the allowed amount came in under the contracted rate, and because nothing was denied, nobody looked. This seat spends its day comparing remittance lines against the fee schedule loaded for that payer and that date of service, building the variance list and preparing the appeals your billing lead approves. Left undone, the loss is silent: no denial, no work queue, no alert. Just money you earned, allowed at less than the agreed rate, and never asked for again.
What the seat actually does
- Load your contracted rates into whatever holds them — the contract module in your PM, or a worksheet — one payer, one plan, one effective date at a time.
- Compare the allowed amount on each remittance line against the rate in force on that date of service, not the paid amount, which patient responsibility legitimately reduces.
- Flag every line that came in short, including the few-dollar ones, then group the list by payer and by pattern so a repeating shortfall is worked once as a batch.
- Prepare the appeal or reprocessing request, citing the contracted rate and the identifiers that payer asks for, and file it once your billing lead signs off, inside the appeal window.
- Chase each filed line by phone until it closes — paid, adjusted, or refused in writing — with every call logged against the payer reference number and the outcome.
- Report weekly: recovered, still open, and which payers allow under contract in the same place month after month — the evidence your side takes into renewal.
What it costs
$1,900
Per seat, per month, in US dollars. Full time, forty hours a week, on US hours — not per hour, not per claim, and never a share of your collections.
Compare against the other 21 roles →
The denial codes this seat works
2 codes, grouped the way the queue is worked rather than by number. Each one links to what causes it, the order to work it, and how to stop it recurring.
Worked by being checked against the contract before any work is done
- N381 — Per contractAn alert, not a denial: the payer processed the line under your contract and is pointing you at it. The reason code beside it carries the money.
- N830 — No Surprises ActAn out-of-network service the payer processed under federal or state surprise-billing rules: the patient owes only the PR amount, and any dispute over the payment is with the payer, not the patient.
Working a denied claim costs $57.23 per denied claim in administrative time (source) and about about 90% of initially denied claims are eventually paid. The reason they sit is almost never that nobody knows how. It is that nobody has the hours.
How a seat starts
You issue one named login. We sign the Business Associate Agreement before it is used. We agree the numbers you will judge the seat on, which you pick and you measure. Then we train for about a week on your workflow and the seat starts. Every Friday you get a written report of what was done, what the numbers were, and what went wrong.
Questions
How much does underpayment recovery & contract variance cost?
$1,900 per seat per month. That is a full time person, forty hours a week, working United States business hours. Not per hour, not per claim, and not a percentage of what you collect.
Is there a minimum contract?
One seat for one month, cancellable with thirty days notice. There is no annual lock-in.
Do we have to change systems?
No. The work happens inside whatever you already use, through a named login you issue. We do not sell software and we do not route your data through anything of ours.
How quickly can a seat start?
About a week from the agreement, which covers training on your workflow, your payer mix and your system. You are not charged extra for that week.
We have never loaded our fee schedules anywhere. Can the seat still start?
Not on day one, and not without you. Somebody at the practice has to say which executed contract and which amendment is the live one for each payer and plan — that document only you hold. The seat can request a current schedule through the provider portal or the payer representative, but expect resistance: some payers will only confirm rates code by code, and some will not put a full schedule in writing at all. Pick your two or three largest payers, get those contracts and their effective dates to the seat in week one, and the variance work starts there while the rest are gathered.
Doesn't our practice management system already flag underpayments?
If you have a contract management module and the rates in it are loaded, current and matched to the right effective dates, the flagging is already done — what is usually missing is a person who works the flagged list every day. That is what this seat is. With no module, the comparison runs in a worksheet against posted remittances: slower to set up, the same arithmetic afterwards, and only as good as the remittance detail your system can export. Either way the seat works inside your system, on logins you issue, under your direction.
Who decides whether a shortfall is really an underpayment?
Your credentialed coder or billing lead does, not the seat. Some shortfalls are plain contract arithmetic — the wrong fee schedule version, the wrong units, a reduction applied where the contract does not allow one. Others turn on coding, bundling or modifier questions, and that judgment has to sit with the person who carries coding responsibility. The seat prepares the file — the line, the expected rate, the contract page, the remittance — and hands it over for a decision. It does not assign or change codes, and it does not decide what to write off. Accepting a payer's position is always your call.
How small is too small for this to be worth 1,900 a month?
If you bill a handful of payers at low monthly volume, a full-time seat is unlikely to recover its own cost, and we would rather say so than take the money. Nothing here is contingent either: the fee is the same whether recovery is large, small or nil, and a fair share of flagged lines turn out to be correct once the contract is read properly. This suits a practice with several commercial contracts and enough paid volume for one person to have a variance queue in front of them daily. The one-month minimum, paid up front with thirty days' notice after that, is the cheapest way to find out: a first pass on your largest payer sizes the pot before you commit further.
What actually arrives each week?
A variance list and a movement report: what was filed, what closed, what was recovered, what was refused and the reason given. Alongside it, the pattern list — where the same payer allows under contract in the same place, month after month. That list is the point. Recovering one claim is money; showing exactly where a payer underpays, with the lines to prove it, is what you carry into the next renewal. Renegotiating the contract stays with you and your advisors.
Next step
Try one underpayment recovery & contract variance seat for a month
$1,900 for the month. If it does not earn its keep, cancel it. Twenty minutes on a call is enough to tell whether it fits.
Or write to ops@softhomeglobal.com