UCG SOLUTIONS
A paid claim is not always a correctly paid claim.
UCG helps identify reimbursement variance by comparing expected reimbursement, contract logic and actual payer payment, then prioritizing recovery and systemic prevention.
Scope of support
- Expected-versus-actual reimbursement analysis
- Contractual underpayment review
- Payment variance identification
- Payer payment accuracy analysis
- High-dollar variance prioritization
- Historical / retrospective review
- Appeal and payer follow-up support
- Root-cause and trend analysis
- Recovery tracking and reporting
Common risks and triggers
- Incorrect contract rates
- Bundling or payment-policy issues
- Unexpected adjustments
- Incorrect fee schedule application
- Missing carve-outs
- Payer processing errors
- Repeated low-dollar leakage at scale
HOW THE WORK MOVES
Follow this capability through its operating steps.
Select each stage to inspect the task, the issue to watch, an example action and the accountable reviewer.
WORKFLOW EXPLORER
Expected payment to variance resolution
Show the analytical and operational steps behind a payment-variance review.
SELECTED STAGE
Expected amount
The applicable contract terms and claim context establish a comparison basis.
Illustrative operating sequence. Final responsibilities, payer rules and automation scope are confirmed for each engagement.
Organizations served
- Hospitals & Health Systems
- Physician Groups
- Ambulatory Surgery Centers
- BPO & KPO Organizations
INTELLIA relevance
UCG INTELLIA™ supports operational visibility, prioritization and workflow automation across revenue-cycle work, with review roles defined for each process.
- Underpayment Intelligence: Compare expected and actual reimbursement, flag variance and prioritize recovery.
- A/R Intelligence: Segment accounts by age, value, payer, denial status and recovery potential.
- Revenue Analytics: Connect operational and financial KPIs into role-relevant views.
Related services
Discuss your workflow with UCG.
Share the revenue-cycle issue, operational priority or payer challenge you are working through.
Assess Underpayment Risk