Every PPO contract you hold promises an allowed amount per code. Your ERAs say what the carrier actually paid. Almost nobody reconciles the two line by line — so quietly, on some codes, they stop matching.
Nobody at the carrier decided to pay you less than your contract says. It happens in smaller, duller ways. A fee schedule is updated and the notice lands in a mailbox nobody reads. A code is downgraded on adjudication — a posterior composite paid at the amalgam allowance — under a clause you agreed to in 2019 and haven't seen since. A contract was loaded into the practice‑management system with a typo, and every claim since has been compared to the wrong number. A leased network changes which schedule applies without changing the name on the card.
None of that is visible at the level of a single claim. Each EOB looks plausible on its own. The pattern only appears when thousands of claim lines are compared against the agreement in force on each date of service — which is exactly the work a front desk never has time to do.
The per‑claim gap is small; that is why it survives. Five dollars and eighty‑five cents on a prophy. Thirteen‑eighty on a composite. Eighty‑one‑fifty on a crown. Multiply by a year of claim lines and a modelled single location can be short by tens of thousands of dollars on one carrier. Across a group it is a line on the income statement that nobody has ever seen, because it has never been measured.
It matters twice for a group. Once because the money is yours. And once because a buyer's quality‑of‑earnings review will not credit revenue you cannot show you're contractually owed — but will happily use unverified payer behaviour as a reason to discount.
You do not need software to find out whether this is a problem for you. Pull three recent EOBs from one carrier. On each, find the allowed amount for a common code — a periodic evaluation (D0120), an adult prophy (D1110), a one‑surface posterior composite (D2391), a crown (D2740). Now find the same codes on the fee schedule you signed with that carrier, in force on those dates of service. Compare.
If they match, good: that carrier, on those codes, is paying to the penny, and you have learned something worth knowing. If they don't, you have found a discrepancy worth raising — and, more usefully, you have the two pieces of paper you need to act: the contract line and the ERA line.
Three things, in order. Reprocess — most carriers will reprocess a claim paid below your contracted rate when you cite the schedule and the line — unless a leased‑network rate or a plan downgrade applies, which the reprocessing request will tell you; timely‑filing limits apply, so recent claims first. Reload — fix the fee schedule in your practice system so future claims are compared to the right number and your own reports stop lying to you. Renegotiate — a carrier whose payments have sat below your contracted rate on six codes for eighteen months is a carrier you have a conversation with at renewal.
Contract variance is worth running on any practice's record, for a reason that has nothing to do with software: it is the one finding you can verify against paperwork you already have, without trusting anyone's model. It needs two things you may have to go and find: your ERAs, and the fee schedules you actually signed. If a vendor tells you they found variance, ask for the claim line, the ERA line and the contract line behind each figure. If they can't produce all three, they haven't found anything.
Three EOBs, one carrier, four common codes, your signed schedule. Ten minutes. Write down the four differences, even if they're zero.
Once your ERAs are flowing and your signed fee schedules are in hand, Vella compares every paid line against the schedule in force on its date of service, with the three source lines behind every figure. It shows you the discrepancies; you decide which to raise. It is a priced engagement, and you keep the findings either way. See what a first run looks like →
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