Payment review
In developmentReQover is in development. It is designed to compare claims and payments with the contract information a practice provides, and to prepare a worklist of discrepancies for billing staff.
What it looks for
Downcodes, payments below the contracted rate, and denials worth a second look.
What staff receive
Each item with its evidence and a suggested next step, for billing staff to decide.
The problem
A payment can look reasonable and still be below the rate the practice negotiated, or a claim can be paid at a lower level than billed. Finding these takes time billing teams rarely have.
How it works
A worklist of claims where payment appears to differ from what was billed or contracted, with the evidence for each item and a suggested next step: appeal, documentation follow-up, or no action. Contract comparison and ongoing monitoring are part of the planned design and are not running at practices today.
Billing staff review each item and decide what to pursue. Not every discrepancy can be appealed or recovered.
Staff carry out appeals and follow-up in their existing billing workflow. ReQover does not contact payers.
Availability
In developmentBeing built or evaluated. Not offered to practices yet.
Evidence
Measured
Downcodes logged by billing staff that the detector also found
Limitation: Finding a downcode is not recovering payment.
Measured
Logged downcodes sorted into appeal work versus documentation or education follow-up
Limitation: Not every downcode can be appealed or recovered.
Related workflows
Planned connection. Coding reviewed before the claim is sent.
Planned connection. Operative coding reviewed before the claim is sent.