Out-of-Network Underpayment Recovery for Independent Practices
Happy Billing recovers commercial out-of-network claims that payers and repricers (Data iSight, MultiPlan, Zelis, Naviguard) paid far below fair value. We work on contingency after the payment posts, alongside your current biller, and start with a free underpayment audit.
Repricers have cut out-of-network payments by two-thirds or more. You don’t have to accept the first EOB.
One Manhattan physical therapy practice billed $540 for a four-unit visit. Cigna, repriced through Data iSight, paid $60. The FAIR Health 80th percentile for manual therapy in that ZIP is about $150 per unit. A multi-site practice in Northern New Jersey watched the same visits fall from about $300 to about $100.
Repricers count on practices not having the time or staff to fight back. We do the fighting.
Data iSight / Claritev
Cost-based repricing used by Cigna, Aetna and UnitedHealthcare plans. Dispute windows are short, often 14 days from the EOB, so speed matters.
MultiPlan
Shared-savings and repricing networks layered on commercial plans. We check whether a network agreement actually applies before accepting the cut.
Zelis
Repricing and payment reviews that shrink allowed amounts after the fact. We benchmark every line against FAIR Health for your ZIP and CPT code.
Naviguard
UnitedHealthcare’s negotiation arm for out-of-network claims. Its first offer is a starting point, not the final number.
Who We Help
Therapy and Musculoskeletal Practices
Physical therapy, chiropractic, acupuncture, occupational therapy, podiatry, sports medicine, pain management and orthopedics.
Independent Practices, 1–50 Providers
Owner-led practices with a real share of commercial out-of-network visits, from solo clinics to multi-site groups.
Major Commercial Payers
Cigna, Aetna, UnitedHealthcare and Oxford, and Blue Cross Blue Shield plans including Horizon and Empire/Anthem.
Claims Back to 2022
We review claims back to 2022. The audit sorts them by what is still recoverable and flags claims eligible for a No Surprises Act dispute.
How Underpayment Recovery Works
Free Underpayment Audit
Send us your CMS-1500s and EOBs. We find every claim paid below fair value and total what you are owed.
FAIR Health Benchmarking
We price each CPT code against the FAIR Health benchmark for your ZIP, so every request is backed by independent data.
Batch Negotiation
We group underpaid claims and negotiate them in batches with a payer case manager instead of one claim at a time.
Disputes, Appeals and Complaints
If negotiation stalls, we escalate: formal provider disputes, ERISA appeals, and complaints to NJ DOBI or NY DFS. Typical timeline: 45–90 days.
Contingency Only. Your Biller Stays.
We only get paid when we recover money for you, after the payment posts. Nothing is due upfront. The fee depends on claim age and volume, and you get a clear number after the free audit.
We don’t replace your billing team. We step in only after a claim has been paid, so your biller keeps doing what they do today.
No call needed
Prefer to skip the sales call? Sign our NDA and BAA, upload claims to a secure, HIPAA-compliant SharePoint folder, and we run the audit. Or request your free underpayment audit and we’ll walk you through it.
See how we approach large recoveries in the $32M Recovery Blueprint case study.
Frequently Asked Questions
We already deposited the payment. Is that money gone?
No. Depositing an underpaid check doesn’t close the claim. Depending on the payer and plan, it can still be reopened through reconsideration, negotiation or a formal appeal. The free audit shows which deposited claims are still recoverable.
How fast do we need to act on a Data iSight reduction?
Will you contact our patients?
Does our current biller stay?
How far back can you go?
What does it cost?
Which payers and repricers do you work with?
What do you need from us to start?
Is your out-of-network revenue being repriced away?
Start with a free underpayment audit. We only get paid on what we recover.