Define the claim population
Identify the payers, service lines, facilities, and historical period in question. Confirm which adjudicated claims and remittance records are accessible before sizing a review.
Hospitals, health systems & larger providers
A paid claim can still leave a question.
Check it against the terms.
Claims may be operationally closed while questions about expected reimbursement remain. A useful review tests the payment against the relevant agreement.
Start with a business question. No records or commitment required.
FROM THE QUESTION TO THE EVIDENCE
What belongs in the review.
Compare expected and actual payment
Examine contractual reimbursement terms, payment calculations, adjustments, and recurring patterns. A difference requires validation; a pattern does not automatically establish recoverable revenue.
Check the route to recovery
Review notice and appeal windows, contract rights, documentation, and responsibility for pursuing a finding. Agree on commercial terms and staff responsibilities before a detailed engagement.
MAKE THE FIRST STEP SPECIFIC
What would make this worth examining?
A high-level summary is enough to begin. The team can help clarify the question before requesting detailed information.
- Which payer or payment pattern needs a closer look?
- Are governing contracts and remittances available?
- What review window and appeal deadlines apply?
YOUR ASSUMPTIONS · TRANSPARENT MATH
Explore a scenario.
See what a percentage would mean for a defined review amount. You supply both inputs; this tool does not predict a finding or determine eligibility.
ILLUSTRATIVE DIFFERENCEAdd your assumptions
No recovery percentage is supplied or endorsed by BC Group.
This is arithmetic, before any fees or collection costs. It is not an audit result, a recovery forecast, or a percentage of total annual revenue.
Inputs stay on this page and are not submitted.BEFORE YOU CONTINUE
A few useful answers.
Can the review include claims already marked paid?
Yes, processed claims can be examined against governing terms when records and review rights are available. That is different from assuming that closed claims were underpaid.
Is every identified difference recoverable?
No. Recoverability depends on the verified evidence, contractual rights, deadlines, and applicable process. Identified variance and collected cash must be reported separately.
YOUR SITUATION SETS THE SCOPE
Let’s start with what matters to you.
Tell David what prompted the question, what needs to keep working, and any timing that matters.