VERIFY RevenueFictional TRH demo data — no PHIAs of July 12, 2026

Revenue integrity — expected vs. paid

Payer contract yield, underpayment and denial exposure, and the recovery pipeline for TRH's commercial payers. Figures are aggregate and modeled at the claim-batch / service-line level — no patient-level data.

Data source: 835/837 batch extract · FY2026 Q3 (Apr–Jun 2026). Periodic batch — remittance lag report, not a real-time feed. Next scheduled extract: July 26, 2026.

Expected reimbursement

$77K

Contract-derived allowed

Paid to date

$57K

73.8% blended yield

Underpayments

$7K

Below contract allowed

Denial exposure

$13K

Denials + timely-filing

Recovery

Recovery pipeline & aging

Open, contract-supported recoverable variances by age of the underlying claim in the periodic extract.

Open recovery pipeline

$20,070

8 open variances

0–30 days

$1,110

2 claims · 6% of pipeline

31–60 days

$13,120

4 claims · 65% of pipeline

61–90 days

$2,660

1 claim · 13% of pipeline

90+ days

$3,180

1 claim · 16% of pipeline

Payer scorecards

Contract yield by payer

Each payer is scored through the Foundation-approved VERIFY scorecard engine from manufactured contract terms and batch remittance evidence — with explicit weight-coverage disclosure.

UnitedHealthcaresolid

59.1%

Expected-vs-paid yield · target 98.5%

−3940bps

Gap to target

Expected-vs-paid yield (35%): 82
Clean-claim rate (20%): 88
Denial rate (20%): 74
Adjudication timeliness (15%): 68
Underpayment recovery (10%): 80

Weighted 79 · 5/5 criteria · 100% weight coveredCoverage 96%

Scorecard (CSV)

Blue Cross and Blue Shield of Texassolid

78.8%

Expected-vs-paid yield · target 98%

−1920bps

Gap to target

Expected-vs-paid yield (35%): 78
Clean-claim rate (20%): 86
Denial rate (20%): 70
Adjudication timeliness (15%): 72
Underpayment recovery (10%): 76

Weighted 77 · 5/5 criteria · 100% weight coveredCoverage 92%

Scorecard (CSV)

Aetnasolid

89.9%

Expected-vs-paid yield · target 98%

−810bps

Gap to target

Expected-vs-paid yield (35%): 85
Clean-claim rate (20%): 90
Denial rate (20%): 82
Adjudication timeliness (15%): 78
Underpayment recovery (10%): 86

Weighted 84 · 5/5 criteria · 100% weight coveredCoverage 89%

Scorecard (CSV)

Worklist

Claim / payment variance worklist

Assign, validate, dispute, or mark recovered. Open any claim for the full expected-vs-paid calculation, contract reference, evidence provenance, and chronology.

Payer

Demo action — resets on reload · not persisted

Claim	Payer / service	Type	Expected	Paid	Variance	Age	Conf.	Status
REV-CLM-3001 DRG 291 (Heart failure w/ MCC)	UnitedHealthcare Inpatient medical	Underpayment	$18,420	$15,930	$2,490	38d	86	Assigned
REV-CLM-3002 APC 5375 (Level 5 ortho)	UnitedHealthcare Outpatient surgery	Denial	$9,240	$0	$9,240	52d	71	Disputed
REV-CLM-3003 APC 5024 (Level 4 ED)	UnitedHealthcare Emergency	Underpayment	$1,310	$1,180	$130	27d	78	Validated
REV-CLM-3101 APC 5072 (Level 2 imaging)	Blue Cross and Blue Shield of Texas Outpatient	Bundling	$2,640	$1,990	$650	44d	74	Assigned
REV-CLM-3102 DRG 470 (Major joint replacement)	Blue Cross and Blue Shield of Texas Inpatient surgery	Underpayment	$24,800	$22,140	$2,660	63d	82	Disputed
REV-CLM-3103 APC 8011 (Observation)	Blue Cross and Blue Shield of Texas Observation	Timely-filing	$3,180	$0	$3,180	96d	41	New
REV-CLM-3201 APC 5313 (Level 3 GI)	Aetna Outpatient surgery	Underpayment	$4,760	$4,020	$740	34d	88	Validated
REV-CLM-3202 APC 5023 (Level 3 ED)	Aetna Emergency	Denial	$980	$0	$980	19d	69	Assigned
REV-CLM-3203 DRG 190 (COPD w/ MCC)	Aetna Inpatient medical	Underpayment	$11,260	$11,260	$0	12d	12	Closed — no recovery

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HARS Advisory

Monthly revenue integrity review

What the VERIFY technology identifies from the batch extract, what HARS Advisors validate, what TRH owners decide, and what gets reviewed each cycle.

HARS Advisory operating cadence · Monthly revenue integrity review · quarterly payer negotiation brief

Technology identifies

›Expected-vs-paid variances from the periodic 835/837 batch extract
›Denial and underpayment patterns by payer, service line, and age
›Contract terms not honored (carve-outs, escalators, bundling rules)

Advisors validate

›Which variances are contract-supported and worth pursuing
›Appeal packaging and payer-specific evidence requirements
›Root-cause patterns to escalate into the next JOC / renegotiation

Owners decide

›Which recovery projects to prioritize this cycle
›When to escalate to a payer Joint Operating Committee
›Write-off vs. pursue on low-confidence timely-filing denials

Reviewed each cycle

›Recovery pipeline movement vs. prior month
›Yield gap to contract by payer
›Aging of open recoverable variances

No patient-level data is shown or stored. Claim identifiers are synthetic (REV-CLM-####). Harsight combines periodic batch technology with HARS Advisors — this module is not a real-time claims feed.