RCM · for medical groups, MSOs & specialty practice

Every underpayment,
cited to its contract clause.

PactRecon reconciles every 835 remit line by line against the fee schedules, carve-outs and most-favored-nation clauses already sitting in your payer contracts — and flags every variance within 24 hours.

Book a 20-minute walkthroughSee how it works →
Typical leakage
1–3%
net patient revenue
Time to flag
≤ 24 h
after remittance post
Pricing
Per claim
resolved, not posted
Worklist · Demo tenant
4h post-remit
CPTPayerExpectedPaidStatusΔ
  • 73721 · TCAetna PPO$412.80$381.20
    Drafted
    −$31.60
  • 99214 · 25UHC Choice+$178.40$124.00
    Flagged
    −$54.40
  • 73721 · 26Cigna OAP$489.10$461.00
    Appealed
    −$28.10
Unresolved$114.10
Sch. A-3, p.14 · §4.2(c)

Citations attached to every row

How it works

Three steps. One 24-hour clock. Zero hunting.

Your RCM team stops searching for variances — the worklist arrives with the contract clause attached and the appeal already drafted.

  1. Ingest the contract library

    Every payer contract — fee schedules, carve-outs, modifier rules, site-of-service clauses, MFN floors — is parsed into a clause graph keyed by CPT, POS, modifier and effective date.

  2. Reconcile against the 835

    Each remittance line is matched to its expected rate from the contract graph. Every delta — even $4 — lands on the worklist with the source paragraph attached.

  3. Resolve & recover

    Auto-drafted appeals cite the exact clause, attach the clinical documentation you already filed, and push through your payer portal or paper workflow.

What we reconcile

Every clause that can move money — read and re-read.

The same paragraphs RCM teams already know exist, now enforced on every remit. If it’s in your contract, the engine knows.

  • Fee schedulesContracted-rate ceilings, effective dates, fee-parity
  • Carve-outsPer-CPT/Dx carve-outs and bundled-procedure overrides
  • Modifier logic22, 25, 59, 50, 62, 78, 79 and customary stacks
  • Site-of-servicePOS differential; facility vs. non-facility rates
  • MFN clausesMost-favored-nation rate floors across product lines
  • Timely filingSubmission windows, appeal windows, recoupment cuts
  • Stop-loss / capAnnual or per-claim ceilings on patient liability
  • Retroactive termRe-pricing triggers — never a reminder, always a cite

Sample worklist

3 variances · Day 1
  • Sch. A-3, p. 14

    CPT 73721 — contracted $412.80 · paid $381.20

    − $31.60

  • §4.2(c) MFN

    Pinnacle PPO rate floor $489.10 not applied · paid $461.00

    − $28.10

  • Amend. 2, ¶5

    POS 22 site-of-service differential omitted on 99214

    − $54.40

Every variance ships with the clause citation, the expected rate, the supporting clinical documentation, and a pre-drafted appeal — your team’s only job is the judgment call.

The 24-hour clock

Found in a day. Recovered in the same quarter.

Most teams drive underpayment recovery on end-of-month batches — six weeks after the remit posted. We don’t. Remits reconcile as they arrive, so the appeal clock starts the same hour.

  • Hour 0Clearinghouse posts the 835 remit.
  • Hour 1–6PactRecon ingests & matches against your contract graph.
  • Hour 6–24Variances with clause citations land on the worklist.
  • Hour 24+Auto-drafted appeals queued for human review & send.
time to flag24hRemit → worklist → appeal
Remit postH+24

Integrations

Plugs into the stack you already run.

No EHR rip-and-replace. PactRecon ships as a standalone SKU — read-only against the clearinghouse, read-write against the payer portal, and adjacent to your EHR.

Clearinghouses

  • Availity
  • Change Healthcare
  • Waystar
  • Office Ally
  • Experian
  • Trizetto

EHRs

  • Epic
  • athenaOne
  • eClinicalWorks
  • NextGen
  • Veradigm
  • ModMed

PHI handling

Remit data stays inside your tenant; clinical record pulls are read-only and scoped to the appeal.

No model training

Your contracts and remits are never used to train shared models. Every customer runs a private reconciliation instance.

Audit-ready

Every variance, every appeal, every dollar recovered is logged with clause + remit IDs for payer dispute.

Pricing

Per flagged-and-resolved claim.
The recovered dollar,
in the same quarter as the contract that entitled you to it.

No platform fee, no per-seat charge, no annual contract. We price the unit you can actually attribute a recovered dollar to — a resolved variance — and align our economics with yours.

Email pactrecon@polsia.app↑ Back to top

We respond inside one business day with a sample walkthrough against one of your own payer contracts.