Compare submitted-to vs. paid-by.
That delta is the variance.
A claim can be submitted cleanly, processed without a denial, paid in full — and still be underpaid, because the payer routed it through a leased network with a different fee schedule. The EOB says "paid." Nobody knows. The Variance Router is the function that asks the harder question: was the payment correct?
Cigna DPPO submitted. Connection Dental paid. That is a routing event.
The primary signal is the entity mismatch between the payer you submitted to and the entity that actually paid. Bitewing maintains a canonical registry of TPA entities and their known relationships to parent payers — so when Connection Dental's schedule returns a lower allowed than Cigna's direct schedule, we can price that delta exactly.
Match against the schedule governing on the service date.
The Contract Engine returns the fee schedule version that was in effect on the service date. The Router compares the actual paid amount against that line. Variance is priced to the cent. Where the contract allowed leasing, we separate that from the genuine underpayments — alternate benefit clauses, COB, frequency limits — the discipline is in the classification.
High-confidence dollars, low-confidence queue.
Precision over recall. We target 90%+ precision on flagged variances — when we say it is an underpayment, it actually is. The discipline is in the guardrails, not chest-thumping accuracy claims. Borderline cases go to a human review queue with the exhibits attached, so RCM teams prioritize recoverable dollars per hour of attention, not raw claim volume.
First variance report, target: 14 days.
Read-only access to one location. Two weeks. Priced, cited, appealable variance — or a clean bill of health.
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