58% of medical groups cite payer issues as their top challenge. Pamastay gives you claims-level visibility into denial patterns, coding risks, and contract performance—so you can protect revenue and stay audit-ready.
Payer complexity, denial rates, and audit scrutiny are increasing—while your visibility into claims data stays limited.
Physicians average 39 prior auth requests per week, with 33% initially denied. You're burning staff time on a process you can't optimize because you can't see your approval rates by payer or code.
30% of medical groups report year-over-year revenue decline. Denials, underpayments, and missed charges leak revenue—but you can't see patterns without claims-level analysis.
Multiple payers, different fee schedules, varying contract terms. Are you being paid what you're owed? Most groups can't validate payments against contracted rates at scale.
CMS and payers use predictive analytics systems to flag billing patterns before paying claims. Modifier usage (25, 59), E&M levels, and MUE violations trigger audits you don't see coming.
Wide variation in coding patterns across your physicians—some under-code, some over-code, some have modifier issues. Without benchmarking, you can't identify who needs coaching.
When payers audit, you need documentation to defend your billing. Most groups scramble to pull data reactively instead of having audit-ready evidence at their fingertips.
Claims-level intelligence that helps CFOs and compliance teams protect revenue and reduce audit risk.
Track approval rates by payer, code, and provider. Identify which services qualify for gold card status and where you're losing time to unnecessary denials.
Surface denial trends by payer, reason code, and service type. Identify root causes and quantify revenue impact to prioritize your appeals and process fixes.
Compare what you're being paid against contracted rates. Identify underpayments, incorrect fee schedule applications, and payer-specific discrepancies.
Compare each physician's coding patterns against specialty peers. Identify outliers in E&M levels, modifier usage, and procedure mix for targeted coaching.
Automated detection of MUE violations, modifier red flags (25, 59, etc.), and billing patterns that trigger payer audits—before you submit the claim.
Comprehensive audit trails and exportable evidence to defend your billing when payers come calling. Proactive, not reactive.
See how Pamastay gives medical groups visibility into denial patterns, coding risks, and contract performance.