Read the remittances against the contract
Every service line priced against what you're actually owed. Rates are used only after a human verifies them — an unverified contract produces no dollar figure at all.
Recover the money payers quietly kept. Denied, underpaid, or settled as paid.
Merid reads your remittances against your contracts and the payer’s own policy, drafts cited appeals, and is paid on what actually posts.
Ridgeline Orthopaedics · Worklist
412 findings · ordered by expected value × deadline| Claim | Payer | Cause | Status | Due | At stake |
|---|---|---|---|---|---|
| PCN1003 | Aetna MA | Medical necessity CO-50 | Needs review | 4 days | $2,100.00 |
| PCN1188 | UnitedHealthcare | Prior auth CO-197 | Needs review | 6 days | $1,840.00 |
| PCN1002 | XYZ Healthcare | Underpaid vs contract CO-45 | Drafting | 31 days | $13.00 |
| PCN1150 | Aetna MA | Eligibility CO-27 | Filed | — | $310.00 |
The money is not in dispute. Nobody is going to get it.
80.7%
of appealed Medicare Advantage prior-authorization denials were overturned.
KFF analysis of CMS data
11.5%
of those denials were ever appealed in the first place.
Same dataset
88%
of providers say payer claim disputes are preventing them from getting paid.
HFMA / Guidehouse 2026
Product / How it works
Six steps, in order. Each one leaves a record you can check.
01
02
Separate the four things that look alike
A denial, a partial denial, an underpayment, and a legitimate write-off arrive carrying the same codes. The arithmetic tells them apart — and every finding carries its trace.
03
Pull the evidence the argument needs
The payer's policy at the version in force on the date of service, the contract clause, and only the chart excerpts the stated criteria require.
04
Draft it, and check the draft
A separate pass verifies every factual sentence against the evidence. A draft with an unsourced claim cannot be approved — enforced in the database, not by memory.
05
File it, and keep the receipt
Portal, fax, certified mail, or a rebill through your clearinghouse. The confirmation is archived, because “we never received it” is a real payer response.
06
Track the deadline with its citation
Medicare Advantage, ERISA, and Marketplace plans run on different clocks under different law. When the plan type is ambiguous we take the shorter window — and say so.
Product / Underpayments
The claims marked paid are the ones to read.
When a payer takes a larger contractual adjustment than the contract allows, the claim settles as a zero-balance transaction. No denial code, no work item, no alarm — your software files it under finished.
- Denial tools never see it — there is nothing in the denial queue to see.
- Merid checks every paid line against your contracted rate and surfaces the shortfall with the arithmetic attached.
- For a billing company, this is pure new recovery — money your current process cannot be working, because it was never told it exists.
Billed$150.00
Contracted rate$112.00
Paid + patient share$99.00
Adjustment takenCO-45 · $51.00
Underpaid vs contract$13.00
Product / The audit
An audit you can check yourself.
Send 90 days of remittance files. We send back a report in two strictly separate parts — because one of them is arithmetic and the other is a forecast, and blending them is how vendors lose your trust.
Part 1 — Counted
Deterministic arithmetic on your own files. Every variance, the dollars at stake, and the rule trace behind each line. Nothing here is a model output.
Hand-check any row against your own remittance. That is the point of it.
Part 2 — Estimated
What that is plausibly worth to recover, weighting each finding by published overturn rates for its class. Labelled as an estimate, with the method stated.
Replaced by your own outcomes once we work claims for you.
Company / The ground rules
What we never do.
- We never touch your moneyPayer payments go directly to you, as they always have. We invoice afterward, against remittances that actually posted.
- We never contact your patientsEvery dispute in this system is with a payer. Patients are not part of the work.
- Nothing files without your approvalYour staff approves every draft before anything is sent. A human always decides — and you can turn any of it off.
- We never train on your dataNo customer data trains models, nothing is shared across customers, and AI processing runs under a BAA.
