Step 1 · Snapshot
FREE Snapshot
A first look at where payer risk and revenue opportunity sit in your own claims — no fee to see the picture.
Built for provider practices & revenue cycle teams
Identify Recover Mitigate Risk Drive Compliance
Where is your payer risk — and can you prove it's safeguarded?
That is the question boards of directors ask — and the one billing, coding, and payment-posting automation never answers. RCI gives leadership evidence-backed answers on payer compliance and revenue risk: claims screened against contract rates, underpayments and refund exposure surfaced with the evidence attached, and proof that revenue is protected and risk is minimized over the next five to ten years.
In-network or out-of-network, the standard is the same: the law, the contract, and the plan — not payer policy.
- Claims screened against contracted rates
- Source evidence preserved on every claim
- Findings routed for analyst review
- National prompt-pay screening library
Every finding comes with its evidence.
RCI surfaces underpayment and refund candidates your team can act on with confidence. Nothing is submitted, appealed, or refunded automatically — your analysts make the call.
51
Jurisdiction profiles
State rule library covering all 50 states plus DC.
38 + 13
Preliminary baselines + reviewer workflows
38 profiles carry a preliminary baseline; 13 run as reviewer workflows with no automatic baseline.
407
CARC identifiers recognized
Every published CARC identifier is recognized and preserved in claim evidence.
3
Intake formats
Simple CSV, provider package, and 835 remittance — previewed before anything is saved.
How to engage
Start with the evidence, then decide
Three steps, in order. You see what RCI finds on your own claims before you commit to recovery work.
Step 2 · Assessment
Payer Compliance Assessment
A fixed fee of $2,500–$7,500, set by claim volume — credited toward Recovery Execution if you proceed within 30 days.
Step 3 · Recovery
Recovery Execution
25% contingency on dollars actually recovered or defended — you keep 75%. No recovery, no contingency fee.
How screening works
From raw files to recovered revenue
Every audit batch moves through the same four stages, so no paid line goes unchecked and the evidence trail stays intact from import to recovery.
01
Ingest
Load claims, remittances, fee schedules, and contract documents. Every file is previewed and validated before the batch is saved — duplicates are blocked.
02
Validate
Data is normalized and each line is matched to the contract and rule version that actually applies — payer, plan, dates, and eligibility checked before any math runs.
03
Detect
Deterministic calculations compare expected vs. actual on every line, with explainable exception flags. Lines sort into matched, underpayment candidate, refund candidate, or needs review.
04
Resolve
Analysts verify the evidence, record decisions under their account, and track each finding from Flagged through Recovered or Closed — exported as reports your leadership can rely on.
Self-diagnosis
Where underpayments hide
Underpayments rarely look like denials — a partial payment arrives, the claim closes, and the shortfall goes unnoticed. These are the six places RCI actually screens for it, in plain language.
01
Contract rate & fee-schedule mismatches
The payer paid, but at a lower rate than your contract allows for that code, payer, and date of service. RCI compares every paid line to the contracted rate in effect on that date.
02
Units & modifier discrepancies
Units billed vs. units paid, or a modifier that changes the expected rate and was priced as if it weren't there. RCI checks units and modifiers against the rate that should have applied.
03
Adjustment-code (CARC) misapplication
An adjustment reason that doesn't fit the contract — for example a contractual adjustment larger than the contract supports. RCI recognizes all 407 CARC identifiers and preserves them in the evidence.
04
Patient-responsibility misreconciliation
Deductible, coinsurance, or copay amounts shifted to the patient — or double-counted — so the payer's share quietly shrinks. RCI reconciles patient responsibility before calling anything a variance.
05
Refund & recoupment exposure
Overpayments and recoupment requests sitting unreviewed until they become offsets. RCI surfaces refund candidates early, tracked separately, so your team reviews them before a payer acts.
06
Prompt-pay timing misses
Clean claims paid late under state prompt-pay rules, with no one tracking the clock. RCI screens timing against its 51-jurisdiction library so late payments are visible — analysts verify applicability before anything is pursued.
The product experience
Nine views, one workspace
Unified reimbursement, compliance, and recovery intelligence. Use the sidebar to move through the workspace the way your team will — every view below switches in place.
Executive dashboard
Unified reimbursement, compliance, and recovery intelligence.
Claims analyzed
Every claim line you import, screened against the contracted rate that applies to it.
Potential financial variance
Paid vs. expected across your screened claims — an opportunity signal, not a promised recovery.
Flagged claims
Lines that differ from the contract model, grouped by issue type for review.
Priority review queue
Contractual rate exceptions ranked so your team works the biggest opportunities first.
Financial opportunity by audit category
- Contractual underpayments
- Prompt-payment review
- Medical-policy discrepancies
- Authorization denials
- CARC / RARC inconsistencies
- ERISA process review
- Recoupments
Category totals can overlap — they do not sum into a collectible balance.
The RCI operating model
1 · IngestClaims, remittances, fee schedules, contract documents
2 · ValidateNormalize data and match the applicable contract
3 · DetectDeterministic calculations plus explainable exception flags
4 · ResolveHuman-reviewed evidence, appeals, and recovery tracking
End-to-end intelligence pipeline
01 · ClientSecure onboarding — practice, payers, contracts
02 · IntakeNormalize claim data — CSV and 835 files today, direct connections later
03 · RulesResolve applicability — version, dates, payer, plan
04 · AuditCalculate and flag — expected vs. actual
05 · EvidenceHuman verification — traceable line-level support
06 · ActionRecovery and reporting — disputes, tracking, exports
Start with a pilot audit
A pilot is the low-lift way to see RCI on your own numbers — no system replacement, no clearinghouse change to start.
Step 1 · ShareSend your contracts plus claims and remittance exports — CSV first. Files are previewed and validated with you before anything is saved.
Step 2 · Screen & verifyRCI screens every line against your contracted rates, and analysts verify each finding with the evidence attached — calculation, rule version, and source lines.
Step 3 · You decideYou choose which verified findings to pursue. Nothing is submitted, appealed, or refunded without provider approval.
Your team keeps its current systems and workflows. A pilot uses exports you already have, so there is nothing to rip out and no IT project to start.
Commercial MVP — build first
- CSV claim + payment import and field mapping
- Fee schedule and contract rate engine
- Service-line underpayment analysis
- Evidence ledger and human review
- PDF / CSV reporting and export
Future intelligence modules
- Direct 835/837 and clearinghouse connections with automated reconciliation
- Prompt-payment applicability and penalty review
- ERISA adverse benefit determination analysis
- Payer policy / CARC-RARC pattern detection
- No Surprises Act auditing & IDR support — major feature in active development
- Refunds, recoupments, and recovery automation
Data sources and intake
Claims
CSV / practice-management export — claim ID, service line, CPT, units, modifiers, date of service, payer.
Remittance
835 remittance file or ERA-derived export — payments, allowed amounts, adjustment groups, with envelope and balancing checks on import.
Contracts
Fee schedule — rate, CPT, modifier, payer, effective dates.
Field mapping preview
proc_codeCPT / HCPCSsvc_unitsUnitspayer_paidPaid amountsvc_dateDate of servicecontract_rateAllowed rateEvery file is previewed and validated before a batch is saved — unmatched or ambiguous lines reject the batch rather than disappearing. Future: direct 835/837 and clearinghouse connections. See for how mapped data is priced.
Versioned reimbursement rules
Every rate and rule RCI applies is versioned and effective-dated, so a finding can always be traced to the exact logic that produced it.
Fee schedule rules
Contracted rates by payer, code, and modifier, applied for their effective period only.
Prompt-payment review
State prompt-pay screening for eligible plans — applicability is verified before any rule is applied.
ERISA review
Adverse benefit determination review for applicable benefit plans, with plan and federal requirements checked first.
Traceability principle
Every production finding retains its source document ID, effective period, calculation inputs, rule version, evaluation timestamp, and reviewer disposition. Legal rules are never applied without a verified jurisdiction, plan, and product eligibility check.
Behind this view sits the national screening library: 51 jurisdiction profiles (50 states + DC) — 38 with preliminary baselines, 13 as reviewer workflows — and all 407 CARC identifiers recognized and preserved in evidence.
Contractual underpayment workbench
Line-level findings, calculated deterministically from your contracts — expected vs. actual on every line, with nothing priced by approximation.
Work the queue by finding type
- All findings — the full screened batch
- Potential underpayment — paid below the contracted expectation
- Needs review — codes or terms the model can't price automatically
- Matched — paid equals expected; no action needed
From finding to evidence
Select any finding in the workbench and its evidence card opens — the calculation, the rule version, and the source lines behind it. Batches export to CSV with financial columns in integer cents.
Claim-level evidence card
Every exception is explained with a reproducible calculation — so a reviewer, a payer, or an auditor can retrace exactly how the number was reached.
Service-line calculation
- Units × contract rate = expected allowance
- Expected − patient responsibility − paid = variance
- Positive variance → potential underpayment; negative → refund candidate; zero → matched
Try the arithmetic yourself in The math section below.
Audit evidence
- Rule reference and version applied
- Source files the line came from
- The calculation, shown step by step
- Exception note and review status — human verification required
Validated before anything is labeled an underpayment
Allowed vs. paid, contractual adjustments, multiple remittances, patient responsibility, secondary payments, effective dates, modifiers, and payer/plan applicability are all checked before a line is called an underpayment.
Recovery lifecycle
FlaggedPotential discrepancy identified by screening
ReviewedContract and remittance verified by an analyst
SubmittedAppeal / reconsideration sent through your channels
ResolvedRecovered, denied, or closed — with the outcome recorded
Where recovery is headed
Deadlines, follow-ups, recovery evidence packets, appeal letters, and financial reconciliation are the planned recovery module — built on the same evidence ledger, so every recovered dollar traces back to a verified finding. Nothing is ever submitted automatically; your team authorizes payer outreach only after analyst approval.
Executive audit report
Audit findings turned into client-ready financial intelligence: what was screened, where the variance sits, and what to do next — with candidates always reported separately from verified recoveries.
Inside the report
- Screening scope and period covered
- Aggregate financial variance by audit category
- Traceable exceptions with expected vs. paid calculations and rule references
- Review status and dispositions from the evidence ledger
Recommended immediate actions
- Validate contract amendments and fee schedule effective dates
- Reconcile adjustments and patient responsibility
- Confirm clean source files
- Review exceptions in the workbench
- Authorize payer outreach only after analyst approval
Reports export as PDF and CSV. An aggregate variance figure is an opportunity signal — not a verified recovery estimate.
Development roadmap
Phase 1 · First sellable audit
- CSV data intake + source validation
- Contract and fee schedule matching
- Deterministic service-line calculations
- Exception workbench + evidence ledger
- Human review + exportable report
- Regression testing + audit trail
Phase 2+ · Expand intelligence
- 835/837 native parsing and payer mapping
- Prompt-pay and penalty intelligence
- CARC/RARC trends and payer policies
- ERISA and recoupment intelligence
- Multi-client portal + recovery automation
- Contract modeling for negotiation — model proposed rates against your screened history before the next renewal
Major feature in active development — No Surprises Act
NSA auditing and IDR support is a major RCI feature area in active development — not a someday item. It builds on the founder's decade of out-of-network reimbursement and NSA dispute work. It is not yet shipped: the current product ships contract-rate screening, underpayment and overpayment flagging, 835 remittance intake, prompt-pay screening, and the state rule library.
Before real patient data
Tenant boundaries, authentication and authorization, BAAs, encryption, logging, secure hosting, and a threat review are prerequisites — the guardrails are part of the roadmap, not an afterthought.
What you get
Deliverables you can actually use
Not a score or a black-box alert — concrete work products your team reviews, decides on, and keeps.
Executive dashboard & report
A leadership-ready view of what was screened, where the variance sits by category, and what to do next — with candidate amounts always reported separately from verified recoveries.
Line-level evidence ledger
Every finding carries its calculation, the contract rate and rule version applied, the source files it came from, and the reviewer's disposition — retraceable by a reviewer, a payer, or an auditor.
Recovery pipeline tracker
Each verified finding moves through Flagged → Reviewed → Submitted → Resolved, so nothing your team approves for recovery falls through the cracks.
Exportable audit files
CSV exports with financial columns in integer cents, plus a print-ready executive report — formatted for the conversations you actually have with payers and leadership.
An honest comparison
Why not spreadsheets?
Spreadsheets and variance-only tools each catch part of the picture. RCI's edge is different: every finding is traceable to a contract rate, a rule version, source evidence, and a human reviewer's decision.
| Capability | Manual spreadsheet review | Variance-only tools | RCI |
|---|---|---|---|
| Line-level contract comparison | Spot-checks — volume makes every-line review impractical | Flags totals that differ, often without the contract rate behind them | Yes — every line priced against the contracted rate in effect on its date of service |
| Evidence traceability | Depends on who built the sheet; hard to retrace later | Alert without a reproducible calculation trail | Yes — calculation, rule version, source files, and reviewer disposition on every finding |
| Adjustment-code (CARC) checks | Codes read by eye, claim by claim | Rarely — variance flagged without checking whether the adjustment code fits | Yes — all 407 CARC identifiers recognized; code combinations gate the calculation |
| Prompt-pay screening | Tracked manually, if at all, state by state | No — timing is outside a paid-vs-expected model | Yes — 51-jurisdiction screening library; analysts verify applicability and deadlines |
| Human review before action | Yes, but findings compete with every other spreadsheet task | Varies — alerts often worked without structured verification | Built in — findings are candidates until an analyst verifies the evidence; nothing is submitted automatically |
| Recovery tracking | A separate tracker someone has to maintain by hand | Usually ends at the flag | Yes — Flagged → Reviewed → Submitted → Resolved, tied to the same evidence ledger |
A fair note: if your volume is small and your contracts are simple, a spreadsheet may be enough. RCI is built for when volume, payers, or contract terms outgrow manual review.
Data intake
Three ways in — always previewed first
Choose the format that matches what you have. Every intake is previewed and validated before it is saved as an audit batch, and nothing is silently dropped: unmatched or ambiguous lines reject the batch rather than disappearing.
Format 1 — Simple
Claims + contracts CSV
The fastest path: a claims file and a contract-rates file. Best for a first screening pass against flat contracted rates.
- claims.csv
- contracts.csv
Format 2 — Provider package
Separate payments & refunds
The full provider package: claims, contract rates, and payments as separate files, with refund requests recorded separately from payments — never netted into them.
- claims.csv
- contract_rates.csv
- payments.csv
- refund_requests.csv (optional)
Format 3 — Remittance
835 remittance + source files
A single 005010X221A1 835 transaction screened against its source claims and contracts. Envelope, balancing, and payment checks run on import; raw ERA text is retained with the batch.
- remittance.835
- claims.csv
- contracts.csv
The math
A simple, inspectable formula
RCI's flat-rate model is deliberately transparent. Every candidate amount traces back to two lines of arithmetic and the contract rate you supplied — try it with your own numbers.
The flat-rate model
Expected allowance
units × contract rate
Payer variance
allowance − patient responsibility − paid
A positive variance is an underpayment candidate. A negative variance is an overpayment / refund candidate. Zero is a match. Flat unit rates are supported; complex reimbursement terms route to manual review instead of being approximated.
Adjustment codes gate the calculation: only CO/45 and PR/1, PR/2, PR/3 combinations can pass the code gate for this model. All 407 CARC identifiers are recognized and preserved in evidence — any other combination goes to an analyst with no automatic amount.
Try the calculation
Enter one claim line. This runs the same flat-rate formula in your browser — nothing is stored or sent.
Expected allowance$300.00
Payer variance$30.00
Underpayment candidate
Candidate — verify
Demonstration of the flat-rate model only. In the workspace, code gates, balancing checks, and analyst verification apply before any candidate is acted on.
Who it's for
Built for the people who answer for the numbers
RCI serves any provider market — any specialty, in-network or out-of-network — because regulation enforcement does not depend on network status or payer policy. It is a working tool for provider-side reimbursement and recovery teams, not a dashboard for its own sake.
Specialty practices
The pain: High-value, procedure-heavy claims where a single mispriced rate or modifier quietly repeats across hundreds of lines — and no one has time to reprice them by hand.
- Every line repriced against your contracted specialty rates
- Units & modifier discrepancies surfaced with evidence
- Repeat payer patterns made visible, not anecdotal
Physician groups & multi-provider practices
The pain: Multiple providers, payers, locations, and contract versions — so underpayments hide in the complexity and manual sampling only ever checks a fraction of paid claims.
- Screening across all payers and contract versions at once
- Findings grouped by issue, so the biggest opportunities get worked first
- One evidence trail from source file to final decision
Revenue cycle & practice leaders
The pain: You answer for the numbers, but partial payments make leakage invisible in standard reports — and refund or recoupment requests can arrive with no early warning.
- Executive reporting that separates candidates from verified recoveries
- Refund & recoupment exposure flagged early
- Prompt-pay screening across all 50 states + DC, limits stated plainly
Founder
Kierra Alderman
Founder, Revenue Compliance Intelligence (RCI)
$170 million+
Personally led recovery by identifying payer behavior patterns — the same patterns RCI now screens for.
Kierra Alderman is Founder of Revenue Compliance Intelligence (RCI) and a former Vice President of Revenue Operations at Neuromonitoring Associates. With 20 years in healthcare revenue — 10 focused on out-of-network reimbursement, denial management, and No Surprises Act disputes — she has personally led recovery of more than $170 million by identifying payer behavior patterns.
Credentials at a glance
AAPC Certified Professional Compliance Officer (CPCO) · Six Sigma Black Belt · Master's in Healthcare Administration, University of Phoenix · B.S. in Community Health, UT San Antonio · Harvard Law School — Contract Law · Penn Law — U.S. Health Law, Privacy Law & HIPAA · Johns Hopkins — Healthcare Data Security & Compliance · TEDxSanAntonio speaker
RCI's positioning guardrail: RCI flags potential payer compliance issues with cited evidence for review; it is not legal advice and not a law firm.
Trust & data protection
Built around safeguards — stated honestly
Your claims and contract data are sensitive. Here is how RCI is designed to handle them — described as the requirements the product is built around, not as certifications we claim.
How the workspace is scoped today
- Practice-scoped workspaces — your data lives in your practice's account, not a shared pool
- Authenticated staff roles — findings and decisions are recorded under the account that made them
- Evidence retained per finding — source files, calculations, and dispositions stay attached to the claim line
- Files previewed before saving — nothing enters an audit batch silently
Required before real patient data
Production use with real protected health information requires the full safeguard set on RCI's roadmap — these are prerequisites, not afterthoughts:
- Tenant boundaries between practices
- Encryption in transit and at rest, with access logging
- Business associate agreements (BAAs) in place
- Secure hosting and a completed security / threat review
What we do not claim: RCI does not present itself as HIPAA-certified or compliance-certified, and no such certification is implied anywhere on this page. If your compliance team needs the safeguard roadmap in writing before a pilot, ask — we'll share exactly where each item stands.
Two-minute check
Could revenue be leaking right now?
Answer six honest questions about how your practice checks paid claims today. Your result appears as you answer — nothing is stored or sent.
Revenue leakage self-check
Tap Yes or No for each question. There are no wrong answers — the point is to see where a second look would help.
1. Do you compare every paid claim line to the contracted rate — not just a sample?
2. Do zero-balance claims (paid, but possibly underpaid) get a second look?
3. Can you show the contract rate and clause behind every variance you find?
4. Are adjustment (CARC) codes checked against what your contract actually allows?
5. Do you track how quickly payers pay clean claims, state by state?
6. When a refund or recoupment request arrives, do you already know whether it's valid?
Answer the six questions to see your result
Each “No” marks a place where underpayments or refund exposure can sit unnoticed. Your score updates as you answer.
Request a pilot audit →Honest limits
What RCI does not do
Trust starts with the boundaries. These limits are part of the product — not fine print — so your team always knows what a finding does and doesn't mean.
- !Findings are candidates
Every underpayment and refund finding requires analyst verification before it is acted on. Screening output is a starting point, not a determination.
- !A refund candidate does not authorize a refund
Refund candidates are tracked separately so a human can review, approve, and reconcile. Recovered / Refunded statuses are analyst assertions, not financial transactions.
- !Preliminary baselines are not verified legal deadlines
State baselines are screening references with source links and review dates. Operative authority and exact applicability must be confirmed independently — and no interest or statutory penalty amounts are computed.
- !No live integrations, no automatic submissions
There is no live EHR, clearinghouse, or payer connection, and no automatic appeal or refund submission. Files are imported; people decide what leaves the building.
- !Coverage gaps are stated, not hidden
13 jurisdictions run as reviewer workflows with no automatic baseline, and Washington is aggregate review only. Where the library has no baseline, a reviewer documents the authority and deadline by hand. No compliance certification is claimed.
Common questions
Before you reach out
It's a software workspace. Staff sign in to a practice-scoped account, import claims and contract data, screen it, and work the findings. RCI the product does the screening and record-keeping; your analysts make the decisions.
A finding is a candidate produced by comparing a paid line with the contracted rate and its adjustment codes — an underpayment candidate, a refund candidate, a match, or a line that needs review. Candidates require analyst verification against the source evidence before anyone acts on them.
No. The library holds 51 jurisdiction profiles: 38 with preliminary baselines and 13 reviewer workflows (Washington is aggregate review only). A preliminary baseline is a research trail with sources — not a verified legal deadline — and the prompt-pay checker is a nonpersistent screening tool that works from a deadline your reviewer verifies and supplies.
No — and that's deliberate. RCI has no live payer, clearinghouse, or EHR integration and submits nothing automatically. It prepares organized, evidence-backed findings and tracks reviewer decisions (Flagged, Reviewed, Submitted, Recovered, Refunded, Closed); submission happens through your normal channels.
Yes — that's the point of a pilot. Reach out and we'll walk through the three intake formats, match one to the files you already have, and screen a batch of your own claims and contract rates so you can see the findings, evidence, and reporting on your practice's real numbers.
Spreadsheets work until volume wins: most practices can only spot-check a sample of paid lines, and the evidence behind a finding lives in whoever built the sheet. RCI screens every line against the contracted rate and keeps the calculation, rule version, and source evidence attached to each finding — see the comparison above. If your volume is small and contracts are simple, a spreadsheet may honestly be enough.
RCI's current model prices flat contracted rates deterministically, versioned by effective date, payer, code, and modifier. Terms the model can't price exactly — case rates, percentage-of-charge arrangements, complex carve-outs — are routed to “needs review” for an analyst rather than approximated. You'd rather see an honest manual-review flag than a confident wrong number.
A pilot is designed to be low-lift: no system replacement and no clearinghouse change. You share contract and claims/remittance exports you already produce; RCI does the screening and returns verified findings with evidence, prioritized so your team works the biggest opportunities first instead of hunting for them.
No. RCI provides screening and evidence — it compares payments to your contracts and surfaces candidates for your analysts to verify. State prompt-pay baselines are preliminary screening references, not verified legal deadlines, and nothing in RCI is a legal determination. Confirm operative authority and deadlines with your own counsel or compliance advisors before relying on them.
The minimum is two files: a claims export (CSV) and your contract rates / fee schedule. If you have them, an 835 remittance file or separate payments file strengthens the screening, and refund requests can be included as their own file. Every file is previewed and validated before a batch is saved. Please don't send patient information by email — we'll agree on the right way to share files first.
Contact
Ask for a walkthrough of the workspace
Questions about intake formats, state coverage, the screening model, or a pilot — send a short note and we'll reply with specifics.
Revenue Compliance Intelligence
A provider audit workspace for reimbursement & recovery screening — claims checked against contract rates, evidence preserved, findings verified by analysts.
Coverage at a glance
50 states + DC · 407 CARC identifiers · 3 intake formats
What to include
Your organization type, which intake format fits your data, and the states you bill in.
Request a demo
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