Paste a settlement advice.
See what was actually disallowed.
Line by line: the payer’s stated reason, the ground it falls under, and — the part that matters — how much of the shortfall the advice never explains. That figure is what you can query.
Paste it in
What the TPA sent you
CLAIM NO 4120887 / STAR / IPD BILLED AMT : 1,29,000.00 ELIGIBLE AMT : 86,000.00 DEDUCTION : 43,000.00 REMARKS : AS PER POLICY TERMS ROOM CAT : DELUXE / ELIG: SEMI-PVT PAYABLE : 86,000.00
What it actually says
"As per policy terms" is not a reason. The room category two lines above it is, and it is the line that drove every other deduction on the claim.
It reads the advice you already received. It does not contact the payer, does not file anything, and does not tell you that you will win.
Paste the settlement advice text below. PDF and image upload with OCR are handled server-side once wired.
That was your free run.
Tell us where to send the next one and keep going.
Only the third segment is worth a phone call. It is also the smallest, which is why it disappears inside the total.
What comes back, and in what form.
Start with the half that pays for itself.
Corporate contracts first. The clinical side is an addition, never a precondition.