Executive summary. A lower payment may be entirely correct. Understand why it is lower before accepting it or writing it off.
Definition
An underpayment is a payment that falls below the amount a pharmacy reasonably expected for a claim or service.
Where this work lives in Attergo
Revenue and finance teams start in Attergo Margin. Reconciliation shows which payments raised a question. Remittances, Missing Remittances, Exceptions, and Underpayment Cases hold the individual items. Assign each follow-up to the person who can confirm the payer response, and record the outcome before the case closes.
Start with the payer response and the detail of the prescription or service. A lower payment can come from a deductible, a network rule, a submitted code, a pricing term, or an adjustment applied afterwards. The reason tells you what to do next. The size of the gap alone does not.
Review and follow up
Work from a short checklist: confirm the patient and prescription detail, read the payer codes, check the date and the plan, and note the deadline for any inquiry. Escalate a pattern nobody recognizes rather than leaving staff to guess what a code means.
Final decisions stay with the role your organization holds accountable for them. Record the decision on the item, with the evidence behind it, so the next person to open it does not start over.
Frequently asked questions
Who should use this Attergo workspace?
The role that owns the next action leads it: a billing specialist, an authorization coordinator, an inventory lead, a pharmacist, a compliance lead, or a finance reviewer. Access follows the role your organization assigns.
Referenced standards and further reading
- CMS: Medicare claims processing manuals ↗Centers for Medicare & Medicaid Services
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