Denied and underpaid claims recovery

Find denied and underpaid claims in your ERA and EOB files.

For practice administrators and billing teams at independent specialty practices. MedicalRouter analyzes 835 ERAs and EOB PDFs to surface underpayments, denied claims, and billing errors — with appeal-ready findings for each one.

Allowed − Paid − Patient Responsibility = Net Recoverable

Cigna·Denial·CO-50

$2,100

recoverable

Appeal ready

↑ Example finding. See full sample output below.

No long-term contract · 25% success fee on recovered dollars only · Sign in →

Sample findings from an ERA and EOB analysis

Illustrative output. Structure and logic match what the engine produces from real files.

UHCUnderpayment

$350

shortfall · CO-45

Appeal ready
CignaDenial

$2,100

shortfall · CO-50

Appeal ready
AetnaUnderpayment

$260

shortfall · CO-45

Appeal ready
BCBSDenial

$1,650

shortfall · CO-29

Appeal ready
MedicareUnderpayment

$120

shortfall · CO-45

Review

$4,480 total · illustrative

Each finding includes the math, the payer reason code, and a draft appeal letter ready to download. How denied claims recovery works →

How ERA and EOB analysis works

1

Upload your files

835 EDI files or EOB PDFs from UHC, Cigna, Aetna, BCBS, Medicare, or any major payer.

2

Claims are analyzed

The engine parses each transaction and flags underpayments and appealable denied claims by CARC/RARC code.

3

Review ranked findings

Each finding shows: Allowed − Paid − Patient Responsibility = Net Recoverable, with the full claim detail.

4

File appeals and track recovery

Download the appeal packet. File with the payer. Track each appeal from submitted through to resolved.

Who this is for

  • Independent specialty practices — cardiology, orthopedics, oncology, multi-specialty groups
  • 1–10 providers billing commercial payers and Medicare
  • 50+ claims per month
  • Teams leaving denied claim appeals on the table
  • Practices that suspect short-pays but cannot identify them claim by claim
Not a fit: large hospital systems, RCM vendors reselling to patients, or practices processing fewer than 50 claims per month.

Learn how we handle denied claims recovery →

How your data is handled

  • Files stored in private per-account storage — not shared across accounts
  • Encrypted in transit (TLS). You own your data.
  • Not used to train models or shared with third parties
  • No patient identifiers in system logs

30-day pilot pricing

$500

flat onboarding fee, one-time

+ 25% success fee

on net recovered payer dollars only

  • Full analysis of 835 ERA and EOB files for underpayments and appealable denied claims
  • Net recoverable calculated per claim: Allowed − Paid − Patient Responsibility
  • Appeal packets with denial-specific letter templates, classified by CARC/RARC code
  • No per-claim fees. No per-payer fees. No long-term contract.
The honest framing:If we find nothing actionable, you are out $500. The 25% success fee applies only to payer dollars actually recovered — not patient responsibility, not the setup fee.

By starting the pilot you agree to the Pilot Services Agreement, including the non-refundable $500 setup fee and the 25% success fee terms.

Frequently asked questions

More questions? Full FAQ or contact us.

Ready to see what you are owed?

Upload your ERA or EOB files. You keep all findings — and pay 25% only on what is actually recovered.