UNDERPAYMENT PLAYBOOK · OUT-OF-NETWORK UNDERPAYMENT

How to recover an Out-of-Network Underpayment underpayment

This underpayment is when an in-network claim gets priced at a low out-of-network rate, or a true out-of-network claim is paid below the plan's usual and customary amount.

How it shows up: The claim priced as out-of-network, or a low out-of-network allowed

Why it happens

  • The provider was in-network but the claim priced out-of-network from a loading error
  • The out-of-network allowed came in below the plan's usual and customary rate
  • The wrong TIN or NPI routed the claim out-of-network
  • A contract existed but wasn't linked to the claim

What recovers it

  • Show the in-network contract effective on the date of service and request in-network reprocessing
  • For genuine out-of-network claims, challenge the allowed against the plan's usual-and-customary benchmark
  • Correct the TIN or NPI routing
  • Invoke any state out-of-network or UCR protection that applies

Worth recovering? An in-network claim priced out-of-network is a large, clean recovery once the contract link is shown, and even true out-of-network claims are frequently paid below the plan's own benchmark.

Common questions

How do I recover an Out-of-Network Underpayment underpayment?

This underpayment is when an in-network claim gets priced at a low out-of-network rate, or a true out-of-network claim is paid below the plan's usual and customary amount. To recover it: show the in-network contract effective on the date of service and request in-network reprocessing; for genuine out-of-network claims, challenge the allowed against the plan's usual-and-customary benchmark; correct the TIN or NPI routing; invoke any state out-of-network or UCR protection that applies. Because the claim already paid, the hard part is catching it, reconciling the allowed amount against what you were actually owed.

Is an Out-of-Network Underpayment underpayment worth recovering?

An in-network claim priced out-of-network is a large, clean recovery once the contract link is shown, and even true out-of-network claims are frequently paid below the plan's own benchmark. 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 Out-of-Network 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 out-of-network underpayment shortfalls no one flagged, and works the recovery. You pay 25% only on what's recovered, and nothing if nothing comes back.

Other underpayment types
Paid Below Fee Schedule →Multiple Procedure Payment Reduction (MPPR) →Modifier Payment Reductions (Bilateral, Assistant, Co-Surgeon) →Bundling That Reduced Payment →Sequestration Over-Applied →Silent PPO / Rental Network Repricing →Secondary / COB Shortfall →Outdated or Wrong Fee Schedule →E/M Downcoding Underpayment →Drug / J-Code Underpayment →Missing Prompt-Pay Interest →Recoupment & Offset Errors →Site-of-Service Payment Differential →"Lesser of Billed Charges" Trap →TC/26 Professional-Technical Split Paid Wrong →Global-Period Payment Errors →

Volari's AI agentic crew that works your pile

The same AI agents that reconcile every line and recover your out-of-network underpayment underpayments inside the app, each a specialist at one part of the fight, paid only on what they bring back.

Reva
Lead
Cody
Coding
Denny
Appeals
Faye
Follow-up
Iris
Intel

See what you were underpaid, line by line.

Upload your remittances and Volari reconciles every paid amount against what you were owed. No risk, paid only on what we recover.

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