Underpaid Items Report: Overview


The Underpaid Items Report will help you identify claims the insurance payer did not process at the expected, contracted-allowable amount. For this feature to work appropriately, the contractually allowed amount for each CPT/HCPCS must be entered into the fee schedule by the payer.


Allowed Amount = amount paid by the insurance company + the amount the patient owes. This amount is less the contractual adjustment from the billed charges.

                      Billed charges - contractual adjustment = allowed amount

                      Allowed amount = amount paid by the payer + the amount owed/paid by the patient