Every claim line, checked against what you agreed to pay
inferonIQ matches each claim line N ways: claim ↔ provider agreement ↔ Medicare price list ↔ NCCI edits, and shows the dollar difference on every line.
N-way
Claim Match
Every Line
Paid vs. Expected
NCCI
Edits Applied
Evidence
For Every Finding
The problem
Why manual processes leak money and slow your business.
Rates live in agreements
Negotiated rates and Medicare-based fee schedules sit in provider agreements that the payment system may not reflect.
Coding edits change often
CMS updates the NCCI procedure-to-procedure edits every quarter; unbundled code pairs slip through when edits are stale.
Network status matters
Out-of-network claims for Medicare Advantage members are paid on Medicare terms, and mistakes are easy to miss in volume.
The solution
How inferonIQ solves each pain point.
Agreement rate check
Each paid line is compared with the provider agreement's rate for that code.
Medicare price list
Agreements based on Medicare — physician fee schedule, lab fee schedule, drug ASP, IPPS — are priced from the CMS files, so each line is checked against the exact rate.
NCCI edits
Code pairs that should not be billed together, and units above the limit, are flagged on the claim.
Out-of-network
Out-of-network Medicare Advantage claims are checked against the Medicare rate.
Line-level dollars
Every line shows paid vs. expected and the difference, above or below contract.
Related capabilities
See what we find before you commit.
Read-only connection. We review a sample of your invoices, agreements and supplier spend, then hand back a findings report with specific figures. If there is nothing to recover, there is nothing to pay.