Adjuster.
The person handling the claim at the carrier, TPA or MCO. Who authorizes your work, who questions your invoice, and who you call when a payment comes back light.
One person, several powers.
The adjuster is the claims professional responsible for a specific claim at the payer — a carrier, a TPA, or in Ohio an MCO. They decide what gets authorized, they see what gets billed, and in states where you bill direct rather than to a fee-schedule engine, they are the person whose reading of your invoice decides what gets paid.
In assignment-driven states — North Carolina’s Form 25N, for instance — the adjuster is also where future work comes from.
You will bill this person again next month.
Which changes how a short-pay conversation should go. Before calling, know which of three things happened: a rate difference, a unit difference, or work outside the authorization. Those are three different conversations, and arriving with the wrong one costs credibility you will need later.
Arrive with the billed line, the EOR line, and the dollar gap. Specific, small and documented is what gets a rebill paid. “Something looks wrong with this check” is what gets a callback next week.
Related pages.
Short-pay recovery is what having the exact gap and the original bill in front of you before you dial looks like.
Authorization · EOR · TPA
See your own week run itself.
We load your state’s codes before the call, so you are looking at a caseload like yours inside the first two minutes — not a slide deck.