Every ClaimIQ engagement is scoped upfront with transparent pricing. You know exactly what you're getting and what you'll pay before we begin — and every service is backed by 20+ years of medical billing expertise.
From a one-time spot check to full white-label partnership — there's an engagement model sized for where your practice is today.
| What's included | Spot Audit | Full Practice | Monthly | White-Label |
|---|---|---|---|---|
| Data analyzed | 90 days | 6 months | Ongoing | Custom |
| Denial pattern analysis | ✓ | ✓ | ✓ | ✓ |
| E&M undercoding scan | ✓ | ✓ | ✓ Quarterly | ✓ |
| Full modifier audit | — | ✓ | ✓ Quarterly | ✓ |
| Payer underpayment review | — | ✓ | ✓ Quarterly | ✓ |
| Appeal letters included | 1 | 3 | Ongoing | Custom |
| Findings report | Top 3 | Top 5–10, ranked by ROI | Monthly + Quarterly | Branded |
| Live walkthrough call | 30 min | 60 min with Lex | 30 min/month | Custom |
| Turnaround time | 3–4 days | 5–7 days | 3 days/month | Per SLA |
| Your branding on reports | — | — | — | ✓ |
| Price | $997–$1,497 | $2,500–$4,000 | $800–$1,500/mo | $3K–$8K/mo |
The average independent practice bills $600K–$1.2M per year. Our audits consistently identify 3–7% in missed or recoverable revenue. Use the slider to see what that means for a practice your size.
Every ClaimIQ audit runs through four analytical dimensions. Most practices have issues in at least three.
We analyze every denied claim across your payer mix, flagging patterns by reason code, by CPT code, and by payer. A CO-97 denial cluster from one payer means something different than the same code from another — we classify root causes so you know exactly what's fixable immediately versus what requires a payer escalation. Most practices have 2–3 systematic denial issues that account for 80% of their denied revenue.
We compare your E&M coding distribution against national specialty benchmarks. If your practice is seeing complex chronic disease patients but billing predominantly at 99213, that's money being left at every single encounter. The difference between a 99213 and 99214 is roughly $35–$45 per visit — for a practice seeing 40 patients daily, systematic undercoding can represent $300,000+ in annual missed revenue. We calculate it precisely and tell you what documentation changes support the correct level.
Missing modifiers are one of the most common — and most preventable — sources of revenue loss. A procedure billed on the same day as an E&M without modifier 25 gets denied automatically by most payers. Bilateral procedures without modifier 50, telehealth without the correct place of service code, NCCI bundling conflicts without a 59 or X-modifier — each of these is a systematic issue that compounds across hundreds of claims per year. We identify every gap and provide corrective action language for each.
Your payer contracts set the rates — but payers don't always pay what they've contracted to pay. We compare your actual allowed amounts against Medicare fee schedule benchmarks for your top billed codes. Systematic underpayment of even 10–15% across your highest-volume codes adds up fast. We also flag contracts you signed years ago that may be significantly below current market rates and flag renewal provisions you should be renegotiating.
Start with a free 20-minute billing health check. We'll review your top denial patterns at no charge.
No EHR access needed · HIPAA-compliant · Response within 1 business day