Problem
A leading gastroenterology physician group, with more than 240 doctors operating across two states, knew underpayments were happening but lacked the tools and bandwidth to address them. And without a reliable way to track or quantify the issue, the organization had no clear understanding of the scale of revenue loss or its true impact on the bottom line.
Solution
Adonis partnered with the group to perform a comprehensive review of their historical claims and reimbursement data. Leveraging out-of-the-box dashboards and specialized reports, including the Underpayments report, Adonis Intelligence pinpointed where and when underpayments had occurred. This gave the client a transparent view into the issue, highlighting patterns across payers and specific claim segments where underpayments were occurring.
Outcome
The analysis revealed nearly $500K in underpaid claims within just the first five months of 2024, clearly pinpointing which payers were responsible and where reimbursement had fallen short. With this evidence in hand, the client was no longer operating on assumptions. They had concrete, data-driven proof to take back to payers. Backed by Adonis’ insights, the organization successfully engaged payers to recover owed dollars, improving immediate cash flow while also building leverage for future negotiations. What began as uncertainty around the scale of revenue leakage evolved into a clear path to financial recovery and a data-backed strategy for payer negotiations.
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