No payer sends a letter that says your rate is low. Every claim is paid "as contracted," so underpayment has no alert, no denial, no paperwork. It only shows up when you can finally see what every other provider in your market is actually getting paid. That is what MedReveal gives you.
None of these stories end with a denied claim or a late payment. That is the point. Underpayment is invisible by design — here is what it looks like from inside a practice that never finds out.
For seven years they renewed the same commercial contract, took the annual escalator, and counted each small increase as progress. They never questioned the rate — because they had nothing to question it against. When a benchmark finally placed their top E&M codes at the 24th percentile of the market, the gap was $10–$15 per visit, across thousands of visits a year. Not one claim had been denied. Not one payment was late. The money just arrived, slightly too small, for years.
The payer's negotiator opens a file containing every rate they pay every provider in the market — the full distribution, and where you sit inside it. You open your fee schedule: your own numbers. When the rep says 'this is a standard, competitive rate,' there is nothing in your file that can test that claim. That is not a negotiation problem. It is a data problem, and it sits on your side of the table.
The practice deferred the second ultrasound machine. The new physician hire slipped another year. The supply bill and the malpractice premium went up; the contracted rate did not. There was never a memo that said 'you are being underpaid' — there never is. Underpayment rarely announces itself. It shows up as a margin that never quite recovers, and it reads like normal practice economics.
$10–$15
per visit, on a single high-volume code
24th
percentile — typical for a below-market contract
6 figures
lost per year, quietly, for the life of the term
Underpayment does not announce itself. It compounds quietly, protected by six structural reasons that have nothing to do with how hard you negotiate.
There is no alert, no letter, no remittance note that says your rate is below market. A contract three points under the median generates no flag — just a margin that never quite recovers, on every claim, for the full term of the agreement.
A claim paid at your contracted rate is adjudicated correctly. That is the trap: your claims are fine, and your contract is the problem. The adjudication system has no idea what the market median is, so it never complains on your behalf.
Every rate the payer pays — every provider, every code, every market — is in their files. The same numbers for your own services are not in yours. You negotiate against data you cannot see, and every renewal starts from that gap.
A 3% escalator feels like progress. It rarely touches the real gap, and “this is our standard rate” holds the line whenever you cannot show what competitors are actually paid.
Staffing, supplies and malpractice have all repriced since the contract was signed. Your rate is still being paid in the dollars of the year you signed it, and nothing renegotiates it automatically.
No step in the usual renewal process benchmarks your fee schedule. Not the clearinghouse, not the EHR, not the payer rep. Comparison is the missing step — and it is the one that decides everything.
Every renewal comes down to two documents. One of them contains the answer to "is my rate fair?" The other one is yours. Underpayment is invisible because the data that would reveal it is simply not on your side of the table.
The market medians below are real MedReveal query results — UHC, Family Medicine, Texas, the same office-visit codes most primary care practices bill thousands of times a year. The "current rate" column is an illustrative below-market contract. Nothing in this practice's normal workflow ever flags it.
| Code | Current rate | Market median | Gap / visit | Annual volume | Lost per year | Lost over 3-yr term |
|---|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $52.00 | $62.15 | +$10.15 | 6,000 | −$60,900 | −$182,700 |
| 99214Office visit, established patient, moderate complexity | $78.00 | $92.50 | +$14.50 | 4,500 | −$65,250 | −$195,750 |
| 99215Office visit, established patient, high complexity | $108.00 | $127.60 | +$19.60 | 1,500 | −$29,400 | −$88,200 |
| Total, these three codes | −$155,550 | −$466,650 | ||||
Market medians are real MedReveal query results — UHC published negotiated rates, professional billing class, filtered to Family Medicine taxonomies, Texas. Current rates and annual volumes are illustrative, standing in for the TIN-specific rate and utilization pull a practice runs from its own EHR or clearinghouse.
Every one of those claims was paid "as contracted." No denial, no alert, no letter. The money simply never arrived at the market rate, for the entire life of the agreement — and the practice had no way to know. The gap was only visible the day someone finally compared the contract to the rest of the market.
The fix is not negotiating harder. It is closing the information gap so you know what to negotiate for — and catching the underpaid claims that have already been adjudicated.
We compare your claims against price transparency data and market benchmarks, flagging the codes and payers where reimbursement lands below the distribution — before another renewal locks the gap in for years.
See exactly how much revenue you're leaving on the table, per claim, per payer, per code. The output is a dollar figure you can prioritize — not a vague sense that rates 'feel low.'
Track how your rates sit against what every other provider in your market gets from the same payers, and watch the market move between renewals — so you never re-sign in the dark again.
Identify the payers who consistently pay you below the market, reveal the pattern across your whole contract, and build a targeted recovery or renegotiation strategy from real numbers.
Start from the CPT and HCPCS codes that actually drive your volume — not a generic sample. Those are the codes a renewal decision hangs on.
For each code and payer, get the full distribution of negotiated rates across your state: 25th, median, 75th, 95th percentile, and the provider count behind it.
Drop your contracted rate onto the distribution. The result is a percentile, and the percentile multiplied by your volume becomes a concrete annual loss.
Walk into the renewal with the market position and the dollar figure — or recover the underpaid claims retroactively. Either way, you act from evidence, not assumption.
Send us your top codes and your payers. We will come back with the market distribution for each one and the dollar value of the gap — the number you should have had before the last renewal.