Claims Clarity

Zero-Pay CPT Pattern Detection Module

An Excel-based analytic module that flags repeat $0 or materially reduced CPT–payer payment patterns in already-paid claims — without denials, audits, or recovery services.

What this is

This is a self-contained Excel-based analytic module designed to surface repeat CPT–payer payment patterns that are paid at $0 or materially reduced without being denied.The module applies standardized filters, benchmarks, and aggregation logic to already-paid claim lines to identify silent payment anomalies and estimate exposure.This is a detection and prioritization tool only.

What this is not

  • Not billing or AR services

  • Not payer appeals or follow-up

  • Not contract interpretation

  • Not underpayment recovery

  • Not consulting or audits

  • Not a monthly reporting service

This sample demonstrates structure and logic only. Figures shown are illustrative and not client data.

What you actually get

Excel Workbook:

  • Defined input schema for paid claim lines

  • Built-in filtering logic (excludes denials)

  • CPT-level benchmark calculations

  • CPT–payer aggregation and frequency counts

  • Exposure estimation formulas

  • Ranked output table

  • Example data demonstrating the logic

  • Parameters that can be adjusted internally

Intended Users

This module is intended for analytics, revenue integrity, and reimbursement teams who already work with paid claims data and want a fast way to surface repeat silent payment patterns before deciding whether deeper analysis is warranted.

This site describes an analytic detection module. No billing, recovery, compliance, or payer enforcement services are offered.