The person handling the claim at the carrier, TPA or MCO. Who authorises your work, who questions your invoice, and who you call when a payment comes back light.
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 authorised, 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.
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 authorisation. 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.
Short-pay recovery is what having the exact gap and the original bill in front of you before you dial looks like.
Authorisation · EOR · TPA
Fifteen minutes, your state’s codes on screen — or start the trial and poke around on your own.