Contractual Allowance & Underpayment Estimator
Model how each payer’s contract pays — per diem, case rate, percent of charges, or a flat amount — to estimate expected reimbursement, the contractual allowance, and the effective payment rate against your charges. Add what you were actually paid to surface underpayments. Everything runs in your browser — nothing is saved or sent.
EstimatorBrowser-onlyNo PHIDo not paste patient names, Medicare IDs, SSNs, full claim files containing PHI, or other protected health information. This tool is intended for de-identified examples and educational / reconciliation support. Everything runs in your browser — nothing you paste is stored, logged, or sent anywhere. Enter aggregate financial figures only — this runs entirely in your browser, and nothing is saved or sent. Do not enter patient identifiers.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- Your figures
- Last reviewed
- May 2026
- Last updated
- May 2026
- Primary source
- Standard revenue-cycle formulas
- Formula notes
- Expected reimbursement is computed from the contract method you choose — percent of charges (charges × rate), per diem (per-diem × covered days), case rate (case rate × cases), or a flat amount. Contractual allowance = gross charges − expected. Effective payment rate = expected ÷ charges. Underpayment variance = expected − actually paid.
- Known exclusions
- Computed from the contract terms and figures you enter
- Effective rate compares expected reimbursement to your gross charges
- Underpayment variance is vs. your modeled expected amount, not an official allowed amount
- Excludes bad debt, denials, patient responsibility, and sequestration unless reflected in your figures
- Informational only — not financial or accounting advice
Model each payer’s contract
For each payer, pick how the contract actually pays — per diem × days, case rate × cases, percent of charges, or a flat amount — and enter the terms. The tool works out the expected reimbursement, the contractual allowance, and the effective payment rate against your charges. Add what you were actually paid to flag underpayments.