A payment mismatch occurs when an insurance company either underpays or overpays your practice (according to the payer's allowable schedule) for a service or procedure. The Payment Mismatch Tracking report helps you identify such payments.
You can use the Payment Mismatch Tracking report to identify (and dispute) contracted payment amounts with payers. To use this report, your practice must have payer-specific allowable schedules configured, including minimum and maximum acceptable values. Only charges that are associated with an allowable schedule appear in the Payment Mismatch Tracking report.
Note: If the Payment Mismatch Tracking report results show charges in the "unknown" columns, those codes are not currently listed in the allowable schedule. If all charges appear as unknown, it is possible that no allowable schedule is configured for this payer, or that the allowable schedule is configured incorrectly.
athenahealth recommends defining this allowable information for the top 15 procedure codes for the top 4 payers. To properly configure this information, you should contact the athenahealth CSC by selecting Support > Create Case or Call in the Main Menu.