The claim already paid.
That's why nobody's looking.
Underpayments don't trigger a denial. The EOB posts, your system clears the balance, and the gap between what you billed and what your contract says you're owed just disappears. Incerto checks every line, for every payer, against your actual contracted rates.
* Modeled and third-party figures, sourced below. No commitment, we show you your facility's actual number first.
It doesn't show up as a denial. It shows up as nothing at all.
"When claims are reduced rather than denied, they do not create a worklist item."
Bilateral cataract paid at 150%, not 200%
Commercial payers apply Medicare's bilateral formula instead of the contracted rate.
A polypectomy, paid like a biopsy
CPT 45385 is billed correctly and reimbursed at the base 45378 rate anyway.
A reduction applied to an exempt code
CPT 64484 is AMA-exempt from multiple-procedure reduction. Some payers cut it anyway.
Bilateral FESS, paid as one side
The fee never gets doubled before the claim goes out the door.
Imaging quietly stripped from payment
Fluoroscopy (77003) gets bundled into interlaminar injections it should be billed alongside.
A lens upgrade, never billed
The cost delta on premium IOLs goes uncaptured, case after case.
A documented 90-day audit at one pain-management practice found 38% of nerve-block and epidural claims underpaid, recovering $64,700 across 312 claims once corrected.
— MBW Revenue Cycle Management, 90-day case study
Sources: CertifyHealth payment-accuracy audits; MBW Revenue Cycle Management 90-day case study; AMA CPT guidance on add-on code exemptions.
We check what your billing system assumes is settled.
Contracted rates, loaded at the CPT + modifier level.
Not a summary fee schedule. The actual negotiated rate for every code, every payer, every modifier combination you bill.
Every paid claim, compared line by line.
Not just denials. Every EOB that already cleared gets checked against what the contract actually says.
Ranked by dollar value and recoverability.
Not first-in-first-out. The claims worth chasing surface first.
Recovered through rebilling, negotiation, or appeal.
Whichever path actually gets the gap paid, worked to completion.
Caught earlier next cycle.
Once a payer's underpayment pattern is confirmed, Incerto flags it before the next claim posts, not after.
Modeled against a real $5M ASC, four specialties.
Same 90-day model: 67 claims underpaid against contract, $55,000 in leakage. None of it triggered a denial. All of it posted as paid.
Illustrative model built from HST Pathways, Premier Inc., KFF, and MBW RCM data across the specialty mix described. Not a specific client's audited results. Run your own facility's numbers with the free audit.
Hard numbers.
Not estimates.
* Modeled composite, not a single client's audited results. Sourced above.
Nobody else is looking at the claims that already paid.
Underpayments are the point, not an afterthought.
Most ASC RCM tools stop at denials. We built the rate-comparison engine first.
Every specialty, not just ortho.
GI, ENT, ophthalmology, pain management, and orthopedics each have their own underpayment mechanics. We track all of them.
Contract rates, not guesswork.
Line-by-line comparison against your actual negotiated rates, not a variance estimate.
Paid on recovery, not on seats.
Same contingency model as denials. No recovery, no fee.
Seen in the field.
Real claims. Real numbers.
If we don't recover,
you don't pay.
No monthly fees, no seat licenses. We work on contingency — our incentive is aligned with yours. We get paid a percentage of what we actually collect.
Book a free assessmentNo commitment. We show you the number first.
We show you the number.
Then you decide.
No sales deck. No demos of features you haven't asked for. Just an honest look at what's recoverable in your current claims data.
Send us a sample of recent denied claims.
30–90 days of denial data is enough. We sign an NDA before you send anything.
We run our AI analysis.
Within a few days, our AI agents analyze your patterns and show you exactly which categories are leaking and how much is recoverable.
You see the number.
Hard dollar estimates, not percentages. Then you decide if you want to work together.
You'll speak with someone who has worked real RCM workflows. Not a sales rep.