Compare what a payer was expected to pay against what they actually paid for a CPT code — and flag potential discrepancies worth a closer look.
Illustrative example only — enter your own claim numbers below.
The Underpayment Detector compares the payment you expected from a payer (based on your contracted/allowed amount) against what was actually paid, and calculates the variance. It flags a potential discrepancy requiring EOB/ERA and contract review — it does not claim to prove an underpayment occurred.
Billing managers and RCM teams who want to spot-check a specific claim or CPT code against expected reimbursement.
The CPT/service code, billed amount, expected/contracted allowed amount, and the actual insurance payment received. Patient responsibility and adjustment are optional but improve accuracy.
It gives you a quick, numbers-based starting point before pulling the EOB/ERA or escalating to a payer inquiry.
Provide the CPT code, billed amount, expected allowed amount, and actual payment received.
View the calculated payment variance and whether it suggests a potential underpayment.
Optionally share your contact details to receive a complete written breakdown.
All calculations happen instantly and are verified on our server. No account or payment required to see your results.
Enter your details to receive a full written breakdown with interpretation and recommended next steps.
No. A variance flags a potential discrepancy that requires EOB/ERA and contract review — it may reflect a genuine underpayment, or a contractual adjustment, bundling, or data entry difference.
No, it's optional. If omitted, the expected payer payment uses the full expected/contracted allowed amount, and the report notes this assumption.
Enter the number of similar claims to see a projected total variance across all of them, calculated from the single-claim variance you entered.
No. Only the CPT code and dollar amounts are used — no patient names, dates of birth, or medical record data.
Talk to a 4Arcs Medical Billing expert about payer underpayment patterns and contract review.
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