When the numbers do not explain themselves.
Community, regional and academic health systems carry payer contracts negotiated years apart, under different market conditions, and rarely reconciled in full against what is actually being paid. HealthPulse reviews that reconciliation directly.
Margin pressure that volume and cost do not account for.
When the two obvious explanations are ruled out, the contract-to-payment pathway is where the answer usually sits. When the evidence supports it, the work moves from Validate into Repair: correcting the contract and operating conditions that let drift recur, rather than recovering one payment and calling it done.
Managed-Care Contracting and Reimbursement Drift
Payer contracts reviewed against actual claims and remittance behavior.
Read the capabilityThe Boaz Model
Validate, Stabilize, Repair, Build. Each stage has its own decision gate.
How engagements runIf the margin number will not reconcile, start there.
Tell us what the finance team has already ruled out. That usually narrows the first review considerably.
Discuss a decision