MedSystum is a healthcare financial intelligence platform that transforms complex claims, payment, and reimbursement data into clear insights on financial performance, revenue leakage, and recovery opportunities.
Start with a free audit of the 835 and 837 files you already have — every underpaid or wrongly denied claim, quantified to the dollar. No integration, BAA signed first.
Illustrative — your report reflects your own remittance data
Payers underpay against contracted rates and issue "soft" denials that never get appealed. It hides in the 835s — thousands of line items no human has time to check. The money is real, and most of it is recoverable.
Payers reimburse below your negotiated rates. Line by line the gaps are small; across a quarter they add up. We check every claim against your contract — a CPT fee schedule, or simply “115% of Medicare,” priced from the CMS fee schedule for your locality.
Denials coded as unavoidable that are actually appealable — timely-filing, bundling, and medical-necessity denials that slip past a busy team. We flag the ones worth appealing and read the payer's remark codes to tell you exactly what to fix.
Every finding ties to a specific claim, payer, and dollar amount — a work list your team (or ours) can act on. You see exactly what to recover before spending a minute on it.
We sign a BAA first, then you drop ~90 days of 835/ERA remittance files — plus 837 claim files if you have them, so we can also catch claims that were filed but never adjudicated — to a secure, encrypted destination. Add your payer contract terms — a CPT fee schedule, or just “115% of Medicare” per payer — so underpayments are measured against what you're actually owed. No EHR or clearinghouse integration required.
MedSystum parses each remittance, compares payments to expected contracted rates, and classifies denials — surfacing underpayments and wrongful denials with the reason, payer, and recoverable amount for each.
Within days: total recoverable dollars, a breakdown by payer and denial type, and a prioritized work list. No cost, no obligation — if there's nothing to recover, you've lost nothing.
No dashboards to learn, no data to reconcile. Every finding is traceable to a specific claim and payer, so your team can appeal with confidence.
Built from synthetic claims — no patient information.
Paid $150.00 against 120% of 2026 Medicare (San Francisco, non-facility) = $199.68.
Next step: Submit an underpayment reconsideration citing the contract rate.
Claim lacks information — remark N290: missing rendering provider NPI.
Next step: Add the rendering provider's NPI and resubmit as a corrected claim.
Second procedure paid below 50% of 125% of Medicare (multiple-surgery rule applied).
Next step: Appeal with the contract terms and the operative report.
Illustrative — claims and amounts are examples
Connect the SFTP mailbox where your clearinghouse drops ERAs. MedSystum picks up new 835s automatically every morning — or on demand with one click — and brings in only what's new. Nobody downloading and re-uploading files.
If your clearinghouse delivers 835/ERA files to an SFTP mailbox, it works. Point us at the folder and choose which file names to pick up.
We pin your clearinghouse server's host-key fingerprint. Credentials are only sent to that exact server, and they're encrypted at rest.
Each file is picked up once and logged in a pickup history. A remittance you already uploaded by hand is recognized by its trace number and skipped.
Leave files on the server (the default), move them to an archive folder, or delete them after pickup — your choice, per connection.
Illustrative — file names and counts are examples
Add a recovery line to every client relationship. Run a free audit across your book, show clients the dollars you found, and turn it into a stickier, higher-margin service — no new system for your team.
ASCs and specialty physician groups run high-dollar claims where a small underpayment rate is a large amount of money. Reclaim revenue your current process misses — without adding headcount.
Start with a free audit. Choose the model that fits your business.
A retrospective review of ~90 days of 835s (and 837s)
Your fee is 20% of recovered dollars — with a $250 monthly minimum
Priced by monthly claim volume — for teams that work their own appeals
Tell us a little about your organization and we'll send a BAA and secure upload instructions. From there, your Recovery Report lands in days.
We'll reply within one business day.