Medicaid Managed Care Underpayment Detector
$330.50 in illegal Medicaid MCO reimbursement underpayments identified across across 3 items.
Centene paid $185.00 vs state statutory minimum $345.00. Underpayment is $345.00 - $185.00 = $160.00 per Medicaid Rule 2.
Method1Audited remittance advices against state Department of Healthcare statutory fee schedule.
2Drafted formal MCO underpayment appeal packet and prompt payment interest demand.
| Reference | Description | Underpaid_Amount |
|---|---|---|
| CLM-8802 | Emergency Dept CPT 99285 Underpayment | $160.00 |
| CLM-8803 | MRI Examination CPT 73721 Underpayment | $125.00 |
| CLM-8801 | Office Visit CPT 99214 Underpayment | $45.50 |
Hospital 835 electronic remittance advice claim files, plus state statutory Medicaid physician fee schedule
MCO underpayment demand dossier and state insurance commissioner grievance filing (Resolution Dossier, Findings Schedule)
Run Medicaid Managed Care Underpayment Detector free on the last 12 months of files. If it finds money, the fee is 15 percent of what is actually recovered, nothing on what is not. After that, ongoing monitoring is $1,750 a month. 30% goes to the referring partner.
Read in memory for the session, never stored, never used to train a model.
Outputs are computed from your inputs and the tool's rules. Check them before you rely on them.
Free scan. Pay only on cash recovered.
Run Medicaid Managed Care Underpayment Detector free on the last 12 months of files. If it finds money, the fee is 15 percent of what is actually recovered, nothing on what is not. After that, ongoing monitoring is $1,750 a month.
On a sample file: $330.50 in illegal Medicaid MCO reimbursement underpayments identified across across 3 items.
Why not just use ChatGPT?
Rules that stay current: the rate cards, tariffs, code sets and regulations it checks against are kept up to date for you; a one-off prompt starts from nothing each time. Evidence that stands up: every finding cites the line, the file and the rule, so it holds up with a vendor, a payer or an auditor. The same answer every time: the checks are written rules, not a fresh guess, so this month's result can be compared with last month's. Nobody has to own it: no one inside has to build, test and maintain a home-made tool, and files are not pasted into a public chatbot.
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If you would rather talk it through, write to dev.sathya@baseloom.app; that reaches Dev Sathya, founder.