Reconciliation confirms that two records agree. Revenue integrity confirms that the amount received matches what the contract and the claim actually support.
Knowledge collection
Revenue integrity
How to measure the gap between what a claim should have paid and what it did, explain the gap, and recover it.
Margin leakageUnderpaymentsReconciliationPayer contracts
Articles
A variance means something only when the expected amount behind it has a documented basis, version, and effective date.
Header totals can reconcile perfectly while individual claim lines sit misapplied, unpaid, duplicated, or adjusted underneath them.
An adjudicated claim becomes an actionable exception once it passes a documented payment-cycle expectation for its payer and payment method.
Revenue integrity is the habit of checking whether the work a pharmacy performed was paid correctly, and settling the questions before they become losses.
A lower payment may be entirely correct. Understand why it is lower before accepting it or writing it off.
Reconciliation is the regular comparison of related records to confirm they tell the same financial story.
Related collections
How to
Step by step guides for the work people actually do in Attergo, written from journeys that were run rather than from what the screens appear to offer.
Pharmacy economics
What a pharmacy pays for medication, what it collects for dispensing it, and how long the money sits in between.
Provider status & clinical services
Licences, enrollments, affiliations, and documentation, and how each one decides whether clinical work can be billed.