How to recover a Drug / J-Code Underpayment underpayment
A drug or J-code underpayment is when a payer pays a physician-administered drug below its correct rate, an outdated ASP, the wrong markup, or fewer units than administered, so a buy-and-bill practice earns less than the drug cost, or loses margin, without any denial to show for it.
How it shows up: The allowed on a buy-and-bill drug line is below ASP-plus-your-contracted-markup — paid, but under the drug's real cost basisWhy it happens
- The payer priced against a stale ASP instead of the current quarter's rate
- The contracted markup over ASP (for example ASP+6%) wasn't applied
- Units paid didn't match units administered, shorting the line
- Wastage was administered and documented but not reimbursed
What recovers it
- Compare the allowed per unit against the current-quarter ASP plus your contracted markup
- Confirm the units paid match the units and wastage administered and documented
- Submit the current ASP pricing and contract terms and request repricing
- Reconcile the whole drug line family, since a stale ASP underpays every dose
Worth recovering? Physician-administered drugs are the highest-dollar silent leak in oncology, rheumatology, ophthalmology, and GI, a few dollars off per unit on a high-cost biologic compounds into serious money. Because it prices as paid, only a per-unit ASP-versus-allowed check reveals it.
Common questions
How do I recover a Drug / J-Code Underpayment underpayment?
A drug or J-code underpayment is when a payer pays a physician-administered drug below its correct rate, an outdated ASP, the wrong markup, or fewer units than administered, so a buy-and-bill practice earns less than the drug cost, or loses margin, without any denial to show for it. To recover it: compare the allowed per unit against the current-quarter ASP plus your contracted markup; confirm the units paid match the units and wastage administered and documented; submit the current ASP pricing and contract terms and request repricing; reconcile the whole drug line family, since a stale ASP underpays every dose. Because the claim already paid, the hard part is catching it, reconciling the allowed amount against what you were actually owed.
Is a Drug / J-Code Underpayment underpayment worth recovering?
Physician-administered drugs are the highest-dollar silent leak in oncology, rheumatology, ophthalmology, and GI, a few dollars off per unit on a high-cost biologic compounds into serious money. Because it prices as paid, only a per-unit ASP-versus-allowed check reveals it. A no-risk service makes it easy to find out, you only pay on what's actually recovered, so there's no cost to surfacing the ones that are real.
How does Volari find Drug / J-Code Underpayment underpayments?
Volari reconciles every remittance line's paid and allowed amounts against what your contract and the payer's own rules say you should have been paid, surfaces the drug / j-code underpayment shortfalls no one flagged, and works the recovery. You pay 25% only on what's recovered, and nothing if nothing comes back.
Volari's AI agentic crew that works your pile
The same AI agents that reconcile every line and recover your drug / j-code underpayment underpayments inside the app, each a specialist at one part of the fight, paid only on what they bring back.
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