Paid Below Contract Check
Compare the allowed amount on each 835 service line with the contract rate you supply.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Contract rate
- $150.00 for 99213-25
- Remittance allowed
- $150.00 on one line and $149.99 on another
Result: 1 of 2 matched lines was paid below contract, totaling $0.01.
Answer the questions this way to reach that result. Your own answers give your own.
Inputs and output
- What you enter
One or more X12 835 files and a CSV or TSV fee schedule. Each fee row has a billing code, optional modifier, and either a contracted amount or a reference amount with a contract percentage.
- What you get
- Underpaid service lines, dollar variance, totals by payer and billing code, unmatched-line count, and full or patient-redacted dispute CSVs.
What this is
The remittance allowed amount is the billed charge minus CO adjustments; modifier-specific fee rows take precedence over a code-only rate.
When to use it
Use this before a payment dispute when the payer may have allowed less than the contracted fee. The tool ships no payer rates and makes no assumptions about contract terms you did not enter.
How this is calculated
Citation
CMS Medicare FFS 005010X221A1 Health Care Claim Payment/Advice companion guide for 835 billed, paid and adjustment fields. Contract rates and any reference-price percentage are supplied by the reader. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.