A paid claim is assumed to be paid correctly. Across a year of claims, that assumption is worth checking.
Medlyze matches what the contract says to what the payer paid, line by line, across aged and closed claims, and documents each variance for appeal. Performance-based: you pay when cash is recovered.
Use it to decide whether to audit a payer, prioritize recoveries by value, standardize appeals, or report leakage to finance.
Send a payer and a date range. You get the scope of an assessment and what it would take, within 24 hours.
What changes when the decision is made on the rate of record.
| Code | Your contract | Payer median | Hospital median |
|---|---|---|---|
| DRG 194 | $21,500 | $24,254 | $13,757 |
Contract terms beside the market, code by code.
The comparison that drives underpayment detection: the contracted rate, what the market publishes, and the gap.
Contract-to-payment matching
Every paid line set against the contracted rate, with the variance quantified.
Appeals
A package per variance: the term, the payment and the supporting data.
What does performance-based mean?
No upfront fee, no subscription. You pay a share of what is recovered; if nothing is found, you pay nothing.
How far back?
Twelve to twenty-four months of aged and closed claims: the ones no longer being worked.
Does it replace our RCM system?
No. It sits beside Epic, Cerner, Athenahealth, eClinicalWorks and others as a check on what has already been paid.