How it works
The Historical Revenue Integrity Audit rebuilds the financial path of every claim in the available history — billed, submitted, adjudicated, priced, owed, paid, posted — and reports each break with the evidence that supports it.
Claims, service lines, payer adjudication, remittances, payment posting, encounter data where available, and related financial activity. Most practices export this from the practice-management system and clearinghouse in an afternoon.
Typical sources: 837P claim files, 999 / 277CA acknowledgments, 835 ERAs and scanned EOBs, bank EFT detail, payment postings, eligibility responses.
Applicable contracts, contract versions, fee schedules, benchmarks, effective dates, and other rules required to interpret the claim. Every rule extracted from an agreement is reviewed and approved by a named person before it prices a single claim.
The PDF is the source. The structured rule records the page and section it came from.
For each service line: what was billed, what was submitted, what the payer adjudicated, what the contract calculation produces, what the payer appears to owe after patient responsibility and supported adjustments, what payment evidence exists, and where the balance ultimately landed.
From the practice-level result down to the exact claim line, remittance, payment, contract rule, and source documents that support the finding. Each break is classified — contract variance, payment variance, processing gap, contract opportunity, or data gap — because each needs different evidence and different action.
Evidence before conclusion
Payer allowed is a source fact from the remittance. Contract-calculated allowable is Britepath’s calculation from the approved rule. The report keeps those apart, names the document behind each figure, and says “unknown” when the record does not support a number.
Amount → service line → adjudication → payer obligation → payment / remittance → posting → contract rule → fee schedule → source
Why. Curative agreement (2026), E&M rule: 115% of the Medicare allowable ($108.24), locality 31, lesser of billed charges. Evidence: claim, ERA 2026-09-02, Exhibit A §1.2, fee-schedule rate. See it in the demo →
Seven pages for a fictitious podiatry practice: conclusion, concentration, processing gaps, representative findings, contract performance, methodology, and what happens next.
