Calderwood Health System

8 payers · 3 locations · 2026 contract year · YTD through Sep 2026

This contract year · see the full lookback →

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Lines analyzed

352,663

21,409 underpaid · 6.1%

Total underpayment

$5,278,116

paid below contracted rate

Appealable now

$1,286,965

claim-level, within the filing window

Lost to time

$2,189,608

was appealable — window has closed

Systematic (Class 2)

$1,801,543

$1,171,003 recoverable at 65%

Quarterly revenue analysis

by service date · open any period

Quarter	Underpaid claims	Underpayment
2026 Q3 · partial	6,752	$1,672,346	View report →
2026 Q2	7,413	$1,820,032	View report →
2026 Q1	7,244	$1,785,737	View report →

Underpayment by payer

Top 10

Underpaid CPT codes

Monthly underpayment trend

Recent uploads

File	Period	Lines	Status
calderwood_era_2026_09.835	Jul 3 – Sep 25, 2026	41,944	Complete
calderwood_era_2026_08.835	Jun 2 – Aug 26, 2026	44,341	Complete
calderwood_era_2026_07.835	May 2 – Jul 26, 2026	43,775	Complete
calderwood_era_2026_06.835	Apr 2 – Jun 25, 2026	39,447	Complete
calderwood_era_2026_05.835	Mar 2 – May 26, 2026	41,735	Complete

Detected patterns

3 findings

Westmark Health Plan · CPT 99285 · modifier 25

Westmark Health Plan pays 99285 at 90 % with modifier (none) but only 74 % with modifier 25. Review modifier billing and payer adjudication for this combination.

Audit 99285 modifier-25 claims to Westmark Health Plan and appeal the short-paid lines.

$39,603

671 claims

Westmark Health Plan · CPT 99223 · modifier 25

Westmark Health Plan pays 99223 at 90 % with modifier (none) but only 74 % with modifier 25. Review modifier billing and payer adjudication for this combination.

Audit 99223 modifier-25 claims to Westmark Health Plan and appeal the short-paid lines.

$30,870

694 claims

Westmark Health Plan · CPT 99205 · modifier 25

Westmark Health Plan pays 99205 at 90 % with modifier (none) but only 74 % with modifier 25. Review modifier billing and payer adjudication for this combination.

Audit 99205 modifier-25 claims to Westmark Health Plan and appeal the short-paid lines.

$28,998

687 claims