Every Remittance Audited — Not Every Tenth One
Every ERA line audited at posting, not sampled.
Award-Winning AI Development & Consulting
Revenue Cycle & Insurance
Payers Underpay 1 in 14 Claims
Experian Health and Advisory Board research consistently shows that 7–10% of paid claims contain a payment variance, with total underpayment exposure averaging 1–3% of net patient revenue per year for health systems with active commercial payer contracts.
Read the full evidence
For a $300 million net revenue hospital, that is $3–9 million in contractually owed reimbursement that the payer retained — legally belonging to the provider, contractually enforceable through the dispute and reconsideration process, but invisible to any standard revenue cycle monitoring workflow because the claim was processed and paid, not denied. Each individual variance may be modest — $18 on a $220 physical therapy claim, $340 on a $4,800 surgical assist — but aggregated across thousands of monthly claims, the cumulative underpayment becomes the revenue leakage category that revenue cycle audit firms recover for contingency fees.
$9M A prior-year fee schedule, a missed carve-out, or a misapplied geographic adjustment adds up to $3–9 million per year for a $300M hospital. The AI Underpayment Recovery Agent cross-references every remittance line against your contracted rate in real time, auto-generates dispute letters, and delivers the payer performance data your managed care team needs at the next contract negotiation.
Business impact
7–10%
of paid claims contain a payment variance (Experian Health / Advisory Board benchmark) — the majority accepted silently because payment posting systems have no contract-rate cross-reference layer
- $9M
- Underpayments don't appear in your denial worklist because the claim was paid — just at the wrong rate.
Six Core Capabilities of the AI Underpayment Recovery Agent
Six capabilities that catch every way commercial payers underpay claims.
01
835 ERA Payment Variance Detection
Every 835 ERA is parsed at line-item level for real-time contract-rate checks.
02
Contract Rate Library & Fee Schedules
Upload contracts once — AI builds a queryable fee-schedule and rate library.
03
Dispute Generation & Recovery
On confirmed variance, a payer-specific dispute letter auto-generates.
04
COB & Secondary Payer Recovery
Validates every secondary remittance against the primary EOB for correct COB.
05
Prompt Pay & Interest Recovery
Flags late-paid claims and calculates prompt-pay interest due by state.
06
Underpayment Analytics & Renegotiation
Live view of variance exposure, dispute volume, and recovery rate by payer.
Why Choose the AI Underpayment Agent
Dispute Windows Closed Before They Expire
Variances caught and disputed inside the 90-day window.
Underpayment Data as Contract Renegotiation Leverage
Claim-level payer accuracy evidence for rate renegotiation.
Integrations
Works With Your Clearinghouses, EHR, and Payer Network
The agent plugs into your existing ERA infrastructure — clearinghouses, EHR payment modules, and billing systems.
6 named systems it connects to
Also connects to eClaimLink
Running something not listed here? Tell us on the call — scoping the connector is the first step.
AI Underpayment Recovery Agent
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Epic
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Oracle Health
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Availity
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athenahealth
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Daman
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AI Underpayment Recovery Agent — FAQs
[ 1 ]
What is an AI Underpayment Recovery Agent and how is it different from denial management?
Denial management handles unpaid claims; underpayment recovery handles claims paid below contract. The agent audits every 835 ERA line against the contracted rate and disputes each variance.
[ 2 ]
What are the most common causes of commercial payer underpayments?
Six causes: fee schedule year errors, contract misapplication, bundling variance, modifier downcoding, wrong GPCI or facility rate, and COB errors.
[ 3 ]
How does the payer contract rate library work, and what happens if the contract is not fully digitised?
Document AI parses contract PDFs and fee schedules into queryable rate tables, carve-outs, and effective dates. Unresolved language is flagged for your contracting team.
[ 4 ]
How does the agent handle paper EOBs and non-EDI payers?
AI-OCR digitises paper and image EOBs, and a configurable parser maps proprietary formats to 835 elements. Both feed the same variance and dispute workflow.
[ 5 ]
How does prompt pay interest recovery work, and is it worth pursuing?
The agent calculates statutory interest on late-paid claims (California 1.5% monthly, Texas and New York 45-day rules) and issues demand notices above your threshold.
[ 6 ]
How does the agent integrate with existing payment posting workflows?
It runs as a layer on your existing posting flow: a parallel ERA copy from Availity, Waystar, or Optum is cross-referenced, with variances flagged inside Epic, Cerner, or athenahealth.
[ 7 ]
What ROI timeline and recovery amounts should we expect?
A baseline audit of 12–24 months of paid claims typically recovers $200K–$2M; ongoing detection captures 0.5–1.5% of net patient revenue per HFMA benchmarks.
[ 8 ]
Does underpayment recovery create tension with payer relationships?
Disputes are professionally formatted and cite the exact contract provision and rate, and your contracting team sets the escalation threshold per payer.
[ 9 ]
How does contract variance detection differ from generic claims underpayment software?
Generic tools flag payments below an expected average and produce false positives. Bonami matches each ERA line to the exact contracted rate, so every dispute is defensible.
[ 10 ]
What does the payment variance recovery workflow look like once a variance is confirmed?
The agent classifies the variance, prioritises it by value and dispute window, generates the payer-specific letter, then tracks and escalates it to second-level appeal.
Your Payers Are Keeping Up to $9 Million a Year of Your Revenue. The Claims Were Processed, Accepted, and Paid — Just at the Wrong Rate.
Every underpayment your payment posting system accepts as a contractual adjustment without a contract-rate cross-reference is revenue your payer contractually owes and your health system will never recover once the dispute window closes. Get a live demo of the Underpayment Recovery Agent running against your ERA data and an underpayment assessment showing your current variance exposure by payer, procedure category, and contract year.
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