Recover Underpaid Claims and Fix the Process Permanently
Unlike recovery firms that keep 30% and never explain what went wrong, Medlyze audits every claim line, identifies the root cause, and gives your RCM team a playbook to stop revenue leakage for good.
Zero upfront cost · Zero financial risk · HIPAA-compliant secure portal
Sound Familiar?
Contracts Too Complex to Model Accurately
Carve-outs, stop-loss provisions, and MPPR rules are impossible for standard billing systems to calculate — leaving money on the table with every claim.
Recovery Firms Find It, Keep 30%, and Vanish
Traditional vendors recover underpayments but never explain why the error happened — ensuring you stay dependent on them for the next recovery cycle.
Acquired Practices Hide Systemic Underpayments
As platforms add new practices with disparate PM systems, underpayment patterns compound silently across the portfolio.
RCM Teams Chasing Denials Without Root Cause Data
Without variance detection and root cause analysis, teams fix the same billing errors repeatedly — wasting time and leaving future revenue at risk.
Retrospective Audit: Find Every Dollar You're Owed
We audit every claim line using our proprietary calculation engine — benchmarked against Transparency in Coverage market data. You receive a prioritized recovery report, a contract renewal opportunity analysis based on competitor rates, and a step-by-step recovery playbook for your RCM team.
- Audit 100% of claim lines — not samples
- Prioritized underpayment list ranked by recovery value
- Contract index and renewal calendar for all payer contracts
- Market rate comparison using TiC negotiated rate data
Ongoing Monitoring: Stop Leakage Before It Compounds
After the retrospective audit, Medlyze stays on — detecting new underpayments in real time as claims are adjudicated. Zero-integration setup: simply upload 835s and Claims CSVs to our secure portal.
- Zero-integration setup — upload 835s and Claims CSVs
- Real-time variance detection across all payers
- Root cause analysis pinpoints where and why errors occur
- Fix the process, not just the invoice — permanent operational improvement
Contract Digital Twin: Model Your Contracts Exactly
We build a digital replica of your payer contracts — including carve-outs, stop-loss provisions, and MPPR rules — so every claim is evaluated against what you were actually promised, not a simplified approximation.
- Full fidelity contract modeling including complex clause types
- Automated variance calculation between expected and actual payment
- Supports all negotiated arrangement types: FFS, Bundle, Capitation
- Used as the calculation engine for both retrospective and ongoing analysis
Market Benchmarks: Know Your Negotiating Position
Every audit includes a benchmarking layer — comparing your contracted rates against thousands of payer and hospital competitors using CMS Transparency in Coverage data. Walk into every contract renewal knowing exactly where you stand.
- Benchmark rates by geography, specialty, payer, and billing code
- Identify underperforming contracts to prioritize for renegotiation
- Volume-weighted revenue maximization opportunity analysis
- Defensible data built on CMS-mandated public machine-readable files
Why “Glass Box” Beats the Black Box
Every other vendor finds your money and keeps the explanation to themselves. Medlyze shows you exactly what happened, why it happened, and how to prevent it.
How It Works — Start in 48 Hours
Upload Your Data
Upload historical and current 835 files and Claims CSVs to the Medlyze HIPAA-compliant secure portal. No EMR integration required. Zero IT involvement.
We Audit Every Claim Line
Our calculation engine models your payer contracts as a digital twin, runs every claim against expected payment, and benchmarks results against TiC market data.
Receive Your Recovery Report and Playbook
You get a prioritized underpayment list, root cause analysis, market rate comparison, and a step-by-step recovery playbook — typically within 5–7 business days.
Pricing That Aligns With Your Recovery
Retrospective Audit
Full historical audit of your claims data.
Cash recovered minus a one-time fee based on volume of claims audited
- Complete audit of all historical claim lines
- Prioritized underpayment recovery report
- Contract renewal opportunity analysis
- Market benchmarking against TiC data
- Step-by-step RCM recovery playbook
Ongoing Underpayment ID
Continuous monitoring after the retrospective audit.
Cash recovered minus fixed monthly fee plus gain-share percentage
- Everything in Retrospective Audit
- Real-time variance detection on new claims
- Continuous root cause analysis and reporting
- Operational improvement tracking
- Dedicated Medlyze partnership team
Frequently Asked Questions
What Our Clients Say
“We thought our RCM team was doing a great job, and they were. But Medlyze found $1.8M in underpayments we'd completely missed. It's like having a forensic auditor who only gets paid when they find money. Zero risk for us, pure upside.”
CFO
Chief Financial Officer, Regional Hospital System
“Before working with Medlyze, we were struggling through payer negotiations with no visibility in market rates and little leverage to improve our low reimbursement rates. Medlyze provided the exact support we needed by exposing competitor rates and delivering a clear contract negotiation strategy, finally giving us the data to align our approach. Now, we are positioned to increase our rates with our current payer and have a replicable strategy for future contracts with companies like Cigna.”
Urology Practice Owner
Owner, Colorado Urology Practice
Ready to Find Out What You're Owed?
Get a free underpayment assessment — we'll identify recovery opportunities in your claims data before you commit to anything.
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