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INSURANCE & CLAIMS

Claims adjudication support, cited line by line.

Insurance claims software for cited adjudication support: triage, billing verification, fraud signals, and relatedness tagging — 21 claims-side capabilities that document everything and decide nothing. The adjudicator always signs off on the decision, and all 21 capabilities are included in every subscription, at one flat rate.

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THE CAPABILITIES 21 IN THIS GROUP

Claims decisions stay human. The evidence work doesn't.

Claims-side adjudication support — triage, billing verification, fraud signals, relatedness tagging — the adjudicator always signs off.

Automated Claims Triage

Bulk-processes claim portfolios against your criteria; only claims needing human judgment reach a human.

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Claims Billing Ledger

Every billed amount traces to a source page — click any dollar figure, land on the document that justifies or contradicts it.

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Cost & Care Tables

Billing roll-ups and future-care cost tables, ready for life-care plans and specials.

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Evidence Request Automation

Tracks outstanding record requests with tiered follow-up escalation and a full audit trail.

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Demand Package Audit

Checks every diagnosis, treatment claim, and billed figure in an incoming demand against the record behind it.

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Medical Billing Summary

1-page rolled-up billing summary, grouped by provider/date/category, from the ledger's source-verified data.

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Fraud & Inconsistency Signal Detection

Flags intra-record contradictions and cross-claim provider patterns (cloned notes, upcoding signals) — cited signals for SIU review, not accusations.

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Billed-Charge Reasonableness Benchmarking

Compares every billed amount to UCR/geographic benchmarks and flags outliers with percentile context.

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Treatment Relatedness & Compensability Signals

Tags each visit and charge as related/unrelated/disputed to the covered incident, cited — adjudicator signs off.

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AI-Assisted Medicare Set-Aside Drafting

Drafts the WCMSA allocation from the record at Medicare fee-schedule rates — ready for a certified MSA specialist's sign-off.

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Incoming Demand Letter Intelligence & Structuring

Parses demanded actions, deadlines, policy requests, allegations, injuries, treatments, and billing assertions into cited fields ready for verification.

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Subrogation & Recovery Finder

Scans the record for signals of third-party liability, duplicate coverage, and Medicare, Medicaid, or ERISA recovery opportunities, flagged for your recovery team.

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WORKS WITH

One platform underneath.

Claims work starts with a clean file and cited answers. These groups sit underneath every flag.

Intake & Reading

Deduplication, co-mingled-record quarantine, and table extraction at intake.

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Analysis & Answers

Condition trends, work limitations, and cited answers behind every tag.

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All capabilities

The full platform, every capability, one flat rate.

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Run 1 claim file through it today.

Upload a single claim file and see triage, billing verification, and relatedness tagging work it — every flag cited. Handled under our BAA; never used to train a model.

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