Authored by ASP-RCM Solutions Team · Last updated: May 31, 2026
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Behavioral Health · Multi-site

ASP-RCM Case Study. Parity-act underpayment recovery: $1.2M across 24 months.

A 14-location outpatient psych group suspected they were being underpaid by two managed-care carriers. The CFO had the instinct; she didn't have the data to prove it. An ASP-RCM line-by-line fee-schedule audit, paired with a parity-act argument, recovered the difference, with interest.

By ASP-RCM Case Studies Team · ·
$1.2M
Recovered with interest
14
Locations audited
24mo
Recovery window
2
Payers, both settled

Mental Health Parity Act enforcement has shifted meaningfully since 2023. State insurance commissioners are auditing more aggressively, and group practices that suspect parity violations now have a real path to recovery. The CFO of this 14-location group had the suspicion. She didn't have the line-by-line evidence. We built it.

01 / The hypothesisWhat the CFO suspected

Across two managed-care carriers covering ~40% of the practice's revenue, the contracted rate sheet looked normal. The actual remittances did not. CPT codes that should have paid at $X were paying at meaningfully less. Therapy session codes (90832, 90834, 90837) were the worst offenders.

02 / The auditBuilding the evidence

Three workstreams ran in parallel:

  1. Fee-schedule reconstruction. Pulling actual paid amounts off 24 months of 835s and matching them line-by-line against contracted rates
  2. Parity comparison. Comparing what those carriers paid for medical/surgical equivalents (E/M codes of similar complexity) to what they paid for behavioral health
  3. Pattern analysis. Quantifying the systematic vs. one-off nature of the underpayments

The discrepancy wasn't subtle. Once we had it on a spreadsheet by CPT code, by month, by carrier, the conversation with the carrier shifted in 48 hours.

CFO, outpatient psych group

03 / FindingsWhat the data showed

CPT
Contracted
Actual avg paid
Variance
90832 (30-min therapy)
$72.40
$58.20
↓ 19.6%
90834 (45-min therapy)
$96.80
$78.10
↓ 19.3%
90837 (60-min therapy)
$144.20
$112.45
↓ 22.0%
90791 (eval)
$182.00
$168.20
↓ 7.6%
99214 (E/M med-mgmt)
$128.50
$126.90
↓ 1.2%

Therapy CPTs were being underpaid 19-22%. The medical-management E/M code was paying within 1.2% of contract, the parity gap was unmistakable.

04 / The recoveryHow it played out

  1. Initial demand letter with the line-by-line spreadsheet attached, copying state insurance commissioner
  2. Carrier-initiated reconciliation call within 21 days
  3. First settlement, Carrier A, at 92 days, recovering $720K with interest
  4. Second settlement, Carrier B, at 168 days, recovering $480K with interest
  5. Forward-looking rate correction in both contracts

05 / What keptThe forward-looking discipline

One-time recoveries are nice; structural fixes prevent recurrence. Three changes survived:

  • Monthly fee-schedule reconciliation against actual remittances. Variances above 3% by CPT trigger review.
  • Parity dashboard comparing behavioral-health payment rates against medical/surgical equivalents quarterly.
  • Contract review cadence with carriers, annual, formal, with documented variance acknowledgment.

More engagements: same playbook, different shape.

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Mid-market ABA Audit Defense
$4.8M audit closed with zero clawback in 24 hours.
FL Medicaid

Think you're being underpaid?

A senior partner runs a fee-schedule audit on your top two carriers. You get a CPT-by-CPT variance report. No retainer required for the diagnostic.

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