Attestiq Claims · Healthcare payment assurance
Payers owe you money on claims you already closed.
Underpayments hide because the claim looks paid: the payer allowed something, your system posted it, the balance went to zero, and nobody compared that allowed amount to the contract. We do, on every line — and show you the clause that proves it.
Where this is today
The engine is built and tested; we are running our first audits now. We have no healthcare customers yet, we are not SOC 2 certified, and every figure on this page is generated from synthetic data and labelled as such. We would rather you read that here than discover it in procurement.
How it works
Eight steps, and you approve the one that matters.
Nothing reaches a payer without your sign-off. Everything before that is reconciliation you cannot do by hand at this volume.
- 01
Connect your data
Drop 835 remittances on our SFTP, or export them from athenahealth, eClinicalWorks, NextGen, AdvancedMD or Tebra. A signed BAA comes first, before a single file moves.
- 02
Digitise your contracts
Every fee-schedule line and payment rule becomes a dated term with the page it came from. A person verifies each one before it is ever used to price a claim.
- 03
Reconcile every line
Each remittance line is matched to its contract term. Lines billed but never adjudicated surface too.
- 04
Compute the gap
Expected allowed, from the contract, against what the payer actually allowed. Exact decimal arithmetic, computed by code — never by an AI model.
- 05
Classify the pattern
Fee-schedule drift, bundling against contract, misapplied multiple-procedure reductions, correctable modifier denials — and overpayments you should be reserving for.
- 06
Group into cases
By payer, pattern and month, so one reconsideration covers hundreds of claims instead of one.
- 07
Build the appeal
A letter citing the contract clause and the line evidence, or a corrected claim when the fix is on your side. You approve before anything is sent.
- 08
Match the money
When the payer repays on a later remittance, it is matched back to the case that produced it. That match is the only thing we would ever invoice on.
What we look for
Each finding names the clause it relies on.
A variance alone is not actionable. The pattern decides whether it is an appeal, a corrected claim, or money you should be holding back.
- FEE_SCHEDULE_DRIFT
The payer is still pricing from last year's schedule after a renewal. Dull, systematic, and usually the largest number on the report.
- MPPR_MISAPPLIED
A second or later procedure reduced further than your contract allows.
- BUNDLING_CONTRA_CONTRACT
Denied as bundled where your contract exempts the code — appealed with the clause attached.
- MODIFIER_DENIAL_CORRECTABLE
The payer is flagging a problem on your side. A corrected claim wins; an appeal loses.
- OVERPAYMENT_CLAWBACK_RISK
They paid above contract. We report it so you can reserve, rather than be surprised by the takeback.
A sample report
What lands in your inbox in ten business days.
Generated by the engine from a synthetic remittance — 120 claims, 164 service lines, one fictional payer.
Allowed by the payer
$17,461.50
Allowed below contract
$670.20
Share of allowed
3.8%
Clawback exposure
$295.80
| Claim | Code | Expected | Allowed | Variance | Pattern |
|---|---|---|---|---|---|
| BVM-210037 | 99214 | $142.00 | $131.50 | $10.50 | Fee-schedule drift |
| BVM-210044 | 99213-25 | $98.00 | $0.00 | $98.00 | Bundled against contract |
| BVM-210059 | 11042 | $90.80 | $45.40 | $45.40 | MPPR misapplied |
| BVM-210090 | 99215 | $205.00 | $0.00 | $205.00 | Correctable modifier denial |
| BVM-210090 | J1100 | $2.20 | $116.50 | −$114.30 | Overpayment — reserve |
Synthetic data, for illustration. Real prevalence runs 3–8% of allowed and varies by payer; finding a shortfall and recovering it are different events, and we report them separately.
From finding to recovered dollar
One case per pattern. One approval before anything is sent.
Payers reprocess by pattern, not by line, so a month of fee-schedule drift becomes a single reconsideration request covering every affected claim — and a person signs off on the exact packet before it goes.
- 01
Case
Findings grouped by payer, pattern and service month. The pattern decides the kind: appeal, corrected claim, reserve memo, or inquiry.
- 02
Packet
A reconsideration letter listing every claim with the contracted rate, the amount allowed, the shortfall, and the agreement clause relied on.
- 03
Approval
A named person approves a specific packet, identified by its content hash. If a line changes afterwards, submission refuses.
- 04
Submission
Portal, fax or mail — your choice, your credentials. Status tracked per case against the appeal deadline.
- 05
Recovery
When the payer reprocesses, the difference arrives on a later remittance. It is matched back to the case line by line; that match is the only basis for an invoice.
How we are paid
An invoice line exists only for a recovery matched to a specific later remittance — money that arrived, on a file we can name. Dollars flagged, dollars submitted, and a payer's verbal promise are not on it. Whether the fee is a share of recovered dollars or a flat amount is agreed in writing, before any appeal is filed, in whatever form your state permits.
Your data
Built to hold protected health information.
- A Business Associate Agreement is executed before any file moves.
- Patient names, member IDs and dates of birth never enter our system — the parser keeps a one-way reference and discards the rest at the boundary.
- No AI model ever sees patient identifiers, and no model computes any dollar figure.
- Encryption in transit and at rest, with a separate key per customer, and every access logged.
- Your data is never used to train anything, and never mixed with another customer's.
- Deleted on request at the end of the engagement, with written confirmation.
The offer
Free audit. You decide what happens next.
You send: 90 days of 835 remittances and your top payer contracts. PDFs are fine.
You get back, in ten business days: the underpayment total by payer and pattern, line-level findings with contract citations, your clawback exposure, and a 30-minute walkthrough with the person who ran it.
If we find nothing material, we tell you that and you have lost an hour.
Pricing for recovery work is agreed before any appeal is filed, in writing, and we are confirming with counsel which fee structures are permissible in your state before we quote one.