Your payers tell you what they allowed. Medicare publishes what the work is worth. Almost nobody compares the two.

Why this money never gets worked

A denied claim is visible. It lands in a denial report, somebody triages it, and if it is small it gets written off on purpose because working it costs more than it returns. That is a decision, and it is usually the right one.

MGMA found that only 30 percent of practices audit payer payments monthly. The rest check annually, or never. Not because they do not care, but because checking means comparing every line against a contract, and that is a job nobody has time to do by hand.

What the check actually does

1. 1You drop in a remittance fileAn 835 from your clearinghouse, or an aging export. Twelve months is ideal. It is read from your own disk.
2. 2Nothing uploadsThe analysis runs as JavaScript in your browser tab. Open your network tab before you drop the file and you will see no request. Because the file never reaches us, no BAA is needed to run it.
3. 3You pick your Medicare localityGeography moves the allowed amount by more than 20 percent, so we never guess it.
4. 4You get a numberWhat was paid below the published Medicare allowable, broken out by payer and by code, with the arithmetic shown.

Why your current vendor cannot show you this

Underpayment detection exists. It is sold to hospitals and large groups, and every version of it benchmarks against your own loaded payer contracts. That means handing over your contracts before anyone can compute a single number, which is a procurement project with legal review attached.

The Medicare Physician Fee Schedule is published by CMS, free, and updated quarterly. Benchmarking against it needs nothing but the remittance you already receive. That is the entire reason we can hand you a real figure before you have signed anything at all.

What it costs

No setup fee, no monthly minimum, no annual contract, no per-statement charge, no termination fee. The rate you see is the whole invoice. Published in full at claima.io/pricing.

Two things worth saying plainly

You do not have to fire anyone. This runs alongside whoever bills for you today, on accounts they have already finished with. Read your existing billing agreement first though: some contracts claim an exclusive right to collect on active accounts, and the usual carve-out is for accounts already adjusted to zero balance. We will look at it with you before anything is signed.

A commercial payer has no legal obligation to match Medicare. Commercial contracts are conventionally written as a percentage of Medicare and normally sit above it, so a commercial line landing below that floor is an anomaly worth a look, not proof of anything. Under traditional Medicare the published amount is the allowed amount, so a shortfall there is a real discrepancy. The report labels which is which rather than adding them together.

Who this is not for

• Practices under roughly 200 Medicare claims a year. The arithmetic does not clear the effort.
• Fully capitated books, where there is no fee-for-service line to benchmark.
• Anyone who wants a platform migration. We do not replace your practice management system and will not ask you to.