Commercial Payer Payment Accuracy for Hospital Outpatient Imaging
Claims Clarity reviews already-paid outpatient imaging claims to verify that commercial payers reimbursed according to contract terms — and to identify silent underpayments that often go unnoticed.This is payment verification, not billing
Who This Is ForClaims Clarity works with:Hospital outpatient departments
Community and regional health systems
Facility-based imaging services (CT, MRI, PET, diagnostic imaging)Not a fit if:
Professional fee / physician office only
Billing, coding, or AR outsourcing needs
Denial management or rebilling services
The ProblemMost hospitals assume that once a claim is paid, it was paid correctly.
In practice, commercial payers often:
Apply payment reductions inconsistently
Use outdated or automated logic
Deviate from negotiated contract terms
Deviate from negotiated contract terms
Reduce secondary imaging services without clear visibility
Because these claims do pay, the reductions rarely trigger follow-up — creating revenue leakage hidden inside paid claims.
What We DoClaims Clarity conducts focused payment accuracy reviews of paid outpatient imaging claims to answer one question:Were these claims reimbursed correctly under the contract?Our reviews:
Analyze already-paid outpatient imaging claims (no rebilling, no payer contact)
Identify systematic payment reductions applied by commercial payers
Quantify potential financial exposure for internal assessment
Document payer-specific patterns to support internal recovery or contracting decisions
No workflow disruption. No system changes. No staff retraining.
Entry OfferOutpatient Imaging Payment Accuracy ReviewA short, targeted review designed to assess payment accuracy risk.Includes:
Review of a defined sample of paid imaging claims
Identification of payment reduction patterns
Estimated annualized impact
Clear recommendations for next steps
Does Not Include:
Contract renegotiation
Operational changes
Long-term commitment
This brief intake helps determine whether a review is appropriate for your organization.
About Claims ClarityClaims Clarity provides independent payment accuracy reviews focused on facility-based outpatient imaging.The scope is intentionally narrow and does not include billing, AR follow-up, or coding services.Claims Clarity is a service of Magdovona, LLC.