What the contract says you should have been paid
A health system bills on two forms against a dozen rate structures, and the money sits in the gap between the expected payment and the actual one. Attergo computes the expectation from the contract term that governs each line, and keeps the inputs so the number is still explainable a year later.
Expected reimbursement is not one calculation
A fee schedule, a percentage of charges, a per diem, a case rate and a DRG weighted payment are five different arithmetics, and one institutional claim can involve several at once. Model one of them and approximate the rest and you produce variances nobody trusts. A variance nobody trusts is never worked.
The mechanism behind it.
Eight payment bases, one pricing engine
Fee schedule, percent of charge, percent of fee schedule, per diem, case rate, DRG weighted, pharmacy acquisition plus and capitated run through the same code path, on exact whole amounts, with rounding applied once.
A case rate pays once
A claim governed by a case rate or a DRG produces one expectation for the episode rather than one per line. Pricing each line under a case rate multiplies a single payment by the line count, and every variance downstream of that is arithmetic error.
Two filing clocks, both computed
Timely filing runs from the date of service. The appeal clock runs from the remittance. The platform computes both and ranks the queue by money at risk.
Recoveries with receipts
Money recovered is the sum of the payments recorded against a case, never a figure somebody types. The two eventually disagree, and only one of them has evidence.