You are paid under a contract you do not hold
A Pharmacy Services Administrative Organization contracts with payers and PBMs for the independent pharmacies that belong to it. That arrangement has one operational consequence: the terms deciding what you should have been paid sit outside your own system. Attergo models them as your own contract data, and underpaid goes back to being a figure.
Without the rate, reconciliation is only arithmetic on what arrived
Comparing a remittance against itself confirms what you were paid. It can never tell you what you were owed. The gap appears only when the governing term is present as data, per network and per line of business, and that is precisely the data an intermediated pharmacy is least likely to hold. The underpayment that is systematic, quiet and repeated across every fill on one plan is the one nobody catches.
The mechanism behind it.
Rate schedules held as contract terms
The terms you are paid under are modelled per network and per line of business, with an effective date, so an expectation is computed for each claim rather than assumed from what usually turns up.
The variance names the term that produced it
Expected against actual, per claim, classified. A variance that says a number is short is a starting point. A variance that names the contract term it was measured against is something you can put in front of the party that wrote the term.
Participation, credentials and directory records kept apart
Being in a network, holding a current credential and appearing correctly in a published directory are three facts with three owners and three failure modes. Only one of them stops a claim from paying.
Recoveries are the sum of what was recorded
Money recovered is computed from the payments recorded against a case, never a figure somebody types into a tracker. The two eventually disagree, and only one of them has evidence behind it.
Read the rules from the body that wrote them.
This describes software, not a program. Eligibility, terms, obligations and dates are set and published by the administering body, they change, and they are the version that governs you. Attergo administers no program named here, determines no eligibility and files nothing with an agency on your behalf. No approval, endorsement, participation or affiliation is claimed or implied.