Did the payer pay the rate it published?
Many commercial health plans publish negotiated-rate files. We look for rates associated with your NPI and assess whether a published rate can be matched to a claim payment.
Rate check: $0. Recovery work: 25% of money recovered; $0 if none.
How a variance is calculated
We screen an 835 payment against a candidate published or contract rate, then verify the payer or plan, product, provider arrangement, date of service, CPT code, modifiers, units, and other applicable payment terms.
A lower paid amount is a potential variance, not proof of underpayment. Any next step depends on confirming that the comparison rate and payment terms apply to that claim.
If you authorize a next step, we use the payer or plan's applicable provider-dispute process; the available process varies by plan, product, and regulator.
Every finding carries its source reference: the payer's published rate file and the exact line it came from.
Every figure traces to the payer's published file.
What the record shows
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6,240 → 12,576
Provider complaints filed with California's DMHC roughly doubled from 2022 to 2024.
DMHC Provider Complaint Data, 2024 (PDF) -
Most group health plans and issuers publish pricing information
Federal Transparency in Coverage rules require most group health plans and issuers of group or individual coverage to post pricing information for covered items and services. A posted rate is a screening source and must still be matched to the provider arrangement and claim.
CMS Health Plan Price Transparency -
28 CCR §1300.71.38
For health care service plans within its scope, this rule requires a provider dispute-resolution mechanism and a written determination within 45 working days after receipt.
DMHC Provider Complaint Against a Plan
These sources establish the market and the rules. They are not a claim about any individual recovery.
Terms, plainly
- Rate check: $0.
- Recovery work: 25% of money recovered; $0 if none.
- Recovered money posts to your practice, never to us.
Questions owners ask
- What happens if you find a potential underpayment?
- We show you the source, the calculation, and the payer process that may apply. Nothing is submitted without your approval. PayVariance is not a law firm and does not provide legal advice or legal representation. Rules and eligibility vary by plan and claim.
- Do I have to change billers?
- No. PayVariance is designed to work alongside your existing billing team. Any later remittance review or dispute work begins only after you approve its scope in a separate written agreement.
- What do you need from me?
- For the free check, the form asks for your practice name, NPI, the payer or health plan to check, your name, and email; phone is optional. Do not send patient or claim data through this form. If a later review is appropriate, we will first define the required data, transfer method, and handling terms in writing.
- How long does it take?
- We aim to email the free rate-check result within 2 business days. If you later authorize a provider dispute, timing varies by payer, plan, claim, and governing process. For a provider dispute governed by 28 CCR §1300.71.38, the plan or capitated provider must issue a written determination within 45 working days after receiving it. Other processes have different timelines.
- What if the check finds no usable rate or no recoverable variance?
- The free rate check remains $0. If a later authorized review results in no money recovered, there is no recovery fee. A no-finding result does not establish that every payment was correct.
Check my NPI's rates
We aim to email the published-rate result for the payer you identify within 2 business days. Some payer files may not contain a usable NPI-linked rate. No call. No obligation.
This request collects no patient or claim data — your NPI is public. Do not send patient or claim data through this form or by email.