Underpayment recovery
Find the money hiding in paid claims.
A claim can be paid, posted, and closed at $0 balance, and still be short. Heron checks.
Paid is not the same as paid correctly.
A medical billing underpayment is a payment below what your payer contract and payment rules say you are owed. Heron compares every remit to your contracted allowable, including claims already at $0 balance, and takes the difference back to the payer. Short payments often hide inside a contractual adjustment, the CO-45 line on the remit, which our guide to common denial codes explains.
4 steps from remit to recovery.
Set the expected amount
Your contract, fee schedule, and effective dates give the allowable for each code.
Compare every remit
The 835 payment, adjustments, and patient share, checked line by line.
Confirm it is owed
A difference is a signal to investigate. Heron validates it before asking.
Take it back to the payer
Reprocessing requests or appeals, filed inside the payer’s window and tracked.
What you see, and what Heron does.
Expected payment for every line
Each code priced against your own contracts.
Variance by payer and code
See which payers pay short, and on what.
Disputes with the evidence attached
The contract term, the remit, and the math.
Repeat short-pays flagged
Patterns surface so they stop recurring.
Keep reading.
Common denial codes, explained
What CO-45 and the other codes on your remits mean, and how to fix each one.
Read RevenueThe real cost of a denied claim
What a single denial costs to rework, and why so many are never reworked at all.
Read ServiceAged A/R recovery
How Heron clears claims past 90 days, oldest first, before timely filing closes.
ReadCommon questions, answered plainly.
What is a medical billing underpayment?
An underpayment is a payment below the amount owed under your payer contract and the payer’s payment rules. Confirming one means checking the contract, the remit, the adjustments, and the patient’s share together.
Can a claim with a $0 balance still be underpaid?
Yes. Once a payment and its adjustments are posted, the account can close at $0 even when the payer paid less than your contracted amount. Only a contract-based review finds that difference.
Is an underpayment the same as a denial?
No. A denial means the payer paid nothing for a line. An underpayment is a payment that is too low. Both show up on the remit, but an underpayment often hides inside a contractual adjustment such as CO-45.
What does Heron need to review underpayments?
Your claims and 835 remit files are the starting point. Payer contracts or fee schedules, with their effective dates, let Heron confirm what each payer should have paid. We sign a BAA before any data changes hands.
How far back can an underpayment be recovered?
It depends on the payer. Your contract and the payer’s reprocessing and appeal windows set the limit, so Heron checks the time left on each claim and works the claims closest to their deadline first.
See what your payers paid short.
A free audit of your last 90 days compares paid claims to your contracts and shows the gap, by payer.