Problem 01
Payer products are buried in contracts
Each product can pay differently. Contract terms and claims data are disconnected, making product-specific resolution impossible.
Fee schedule intelligence for specialty practices
Know how rate changes affect your practice’s revenue
Forecast revenue through fee schedule changes, identify likely underpayments, and strengthen payer negotiations. Start with your claims and contracts—no EMR integration required.
Spend less time interpreting contracts
Turn unstructured, written contracts into structured terms to improve financial modeling
Identify likely underpayments
Automate underpayment detection and package evidence for appeal with tailored OCR tools
Plan before new rates take effect
See exactly how proposed fee schedule changes impact providers, locations, codes, and service lines
Negotiate with market benchmarks
Translate payer proposals into actual revenue implications, and compare against competitor and market rate benchmarks
The intelligence gap
Your contracts are complex.
Often covering dozens of unique products, tiebacks, and carveouts—translating written contracts into working financial models can take finance teams weeks of work.
Problem 02
Medicare tiebacks vary by contract
Some agreements update with Medicare, others don’t. Understanding exactly how and why is critical to strategic and financial planning.
Problem 03
Underpayments go undetected.
When contract terms aren't structured and compared against remittance, underpayments get missed.
Fulcrum Light
Forecast revenue without EMR integration.
Fulcrum combines your written contracts, claims, and payer-published in-network rates to forecast revenue, review payments, and compare your position in the market. Start with a claims export and your contract set.
Structures your rates, amendments, Medicare base years, effective dates, and carveouts.
CPT payment data at the claim-line level.
Detailed in-network rate data from all commercial insurers for you, your competitors, and the broader market
Read the contract terms
Structure contracts and fee schedules with OCR and human review.
Resolve the exact payer products
Connect claims to the insurance products and rate schedules that price them.
Model the impact
Reprice claim lines under proposed schedules and compare planning scenarios.
Review payment differences
Check contract terms and published rates, then review evidence for likely underpayments.
What your team can do
Illustrative platform views; figures shown are examples.
Use case 01
Find the services driving revenue changes
Model claim-line impact by service, location, and provider. Toggle proposed policies, compare scenarios, and save analyses to rerun when new data arrives.
Use case 02
Put a dollar value on payer proposals
Upload proposed terms and apply them to your actual volume. Compare rates with other groups contracted with the same payer, by insurance product, to support a counterproposal.
Payment review
Two rate checks
Check contract terms against published rates, then review remittance evidence.
Use case 03
Identify likely underpayments
Compare claims with contract terms and payer-published rates to distinguish contract setup errors from likely underpayments. Review EOB evidence and receive a monthly report with appeal support and next steps.
Use case 04
Identify contracting opportunities
Fulcrum surfaces the employers and plan sponsors in your area with the most competitive network rates, and identifies competitive products you are currently out of network with.
Use case 05
Organize contracts by payer product
Resolve each payer into its exact products and contract terms. See which schedules follow Medicare, which stay fixed, and the annual revenue impact of each.
Use case 06
Track market rates over time
Monthly payer-rate snapshots retain historical context and highlight changes across your contracts, competitors, and geography.
Fulcrum Integrated
Connect reimbursement to service margin and provider pay.
Add EMR encounter data, provider compensation, and supplies and device invoices to understand the costs behind revenue.
See which services cover their costs
Compare reimbursement with recorded physician time, clinical labor, and direct and indirect practice expense. See where time differs from CMS assumptions and which services cost more to deliver than they earn.
Model provider pay alongside profitability
Forecast provider pay and contract margin together. Compare work-RVU efficiency between providers, review results by payer and service category, and identify where compensation could outpace collected revenue.
Start with Light or go directly to Integrated. Light uses claims and contracts without EMR integration. For Integrated, we scope the additional encounter, compensation, and cost inputs with your team.
Discuss Fulcrum IntegratedWho we help
Inform practice and investment decisions.
Practices and MSOs
Build revenue forecasts across providers and locations, compare payer products, and prioritize negotiations and payment reviews.
Health systems
Connect physician-service reimbursement to planning across groups and service lines. Add Integrated to examine service costs and provider compensation.
Healthcare investors
Assess reimbursement exposure in diligence and monitor portfolio practices. Public-data estimates can support early target screening before internal records are available.
Market research and target screening are in beta for selected markets and specialties. Confirm coverage during scoping; valuation advisory is outside our scope.
How we work with practices
One focused analysis or continuous planning.
Both Fulcrum Light engagements begin with a claims export and your contracts, shared through a secure transfer process. No EMR integration is required.
Project-based engagement
One-time analysis
Answer a defined fee-schedule, negotiation, or payment question for a one-time fee.
- Medicare and commercial forecasts by service, location, and provider
- Market comparisons and proposed fee-schedule analysis
- One-time underpayment review and practical next steps
Ongoing engagement
Continuous planning
Keep forecasts, market comparisons, and payment review current as fee schedules and contract terms change.
- Updated scenarios for proposed fee schedules and payer negotiations
- Monthly payer-rate snapshots and underpayment screening
- Alerts for changing or expiring fee schedules, with monthly or quarterly planning support
Get in touch
Discuss your practice’s priorities.
Request a demonstration or discuss an analysis. Tell us your priority; we’ll confirm the scope and secure data-transfer process. No patient data is needed for this first conversation.