What is a contract worth?
A hospital can have hundreds of payer contracts, each with its own rates, carve-outs and escalators. When nobody can say what a claim should have paid, underpayments look exactly like payments. ContractIQ, the platform I lead at Infinia ML, closes that gap for Aspirion and its clients.
This page is an illustrative model, not the ContractIQ interface. The contract and claim are invented, and the defaults come from published industry figures.
Follow one claim
The contract
Inpatient stays are paid at a base rate of $9,800 multiplied by the MS-DRG relative weight. The base rate increases 3% on each contract anniversary.
Payer A (synthetic), now in year 2 of the agreement.
Terms, understood
- Payment method
- Base rate × DRG weight
- Base rate
- $9,800
- Escalator
- 3% each anniversary
A claim arrives
MS-DRG 470, major hip or knee joint replacement. Relative weight 1.90.
Expected payment
$9,800 × 1.03 × 1.90 = $19,179
Variance flagged
Paid $18,620, short $559
The payer kept paying the year-one rate. On one claim it's small. Across thousands of claims and hundreds of contracts, it's a budget line.
Scale it to a health system
in net patient revenue and payer contracts, all invented.
- Underpaid each year
- Recovered each year
- Claims corrected
- Analyst hours returned
Who it helps
Show the math
- Underpaid = net patient revenue × underpayment rate
- Recovered = underpaid × share recovered
- Claims corrected = recovered ÷ typical recovery per claim
- Hours returned = contracts × hours per re-model × re-models per year × share automated
Sources: hospitals lose an estimated 1–3% of net patient revenue to commercial underpayments (Becker's Hospital Review, cited in Revecore's underpayment benchmarks); recovery programs typically yield 0.25–1.25% of net patient revenue (same source); most underpayment recoveries fall between $1,001 and $2,500 (Aspirion client data, HFMA Oregon presentation, 2026). Analyst-hour figures are assumptions for you to set.