The same injury story turns up in forty unrelated files. Reading one at a time, no one connects them.
Claims integrity record review means reading large volumes of clinical documentation against a published rulebook — state fraud statutes for SIU referrals, federal criteria for No Surprises Act IDR, the CMS Program Integrity Manual for audit response — often across dozens of files at once, with a binary or written referee decision on the other end.
SIU files can run to 15,000 pages before a pattern becomes visible, an IDR offer gets a binary answer in writing within days of submission, and the Medicare ADR clock runs forty-five days start to finish. Whatever reads the file has to read all of it, on the clock.
Three steps between intake and a file ready for the deadline.
Upload the claim file or files, any format
SIU claimant files, the IDR-eligible claim documentation, or the ADR request package — scans, PDFs, faxes, handwriting, however they arrive.
The AI surfaces and cites the rulebook-relevant evidence
Pattern matches across files for SIU screening, criteria-mapped entries for IDR, contractor-cited support for audit response — each finding linked to its source page.
The reviewer builds the referral, submission, or response
Verify any entry with a click, then use the cited evidence to build the SIU referral, the IDR submission, or the audit response before the clock runs out.
It surfaces the evidence. The determination stays with the investigator, the IDRE, or the auditor.
Every entry it surfaces carries its citation, so when the record shows a billing pattern relevant to an SIU referral, an IDR criterion, or an audit finding, you can point to exactly where.
What it never does: it never accuses a provider of fraud, never picks the No Surprises Act offer, and never decides a Medicare audit outcome. It surfaces and cites what the record shows — the determination stays with SIU investigators, the IDR entity, and CMS contractors and the appeal bodies above them.
The rules the platform never breaks.
EVERY LINE CITED
HIPAA, under a signed BAA
Every file is handled under our Business Associate Agreement, from the first byte.
Never trains a model
Your records are never used to train any AI model — ours or anyone else's.
Every line cited
If we can't cite it, we don't say it. Every sentence links to its source page.
Deleted after delivery
Files are deleted 30 days after delivery, with a full audit log of every access.
Four capabilities behind every claims-integrity file.
Rulebook-cited review is one deliverable of the same platform that reads, sorts, and cites the whole file.
Medical chronology
Billing and treatment entries merged into one dated timeline, cited to the page.
Verifiable AI Citations
If we can't cite it, we don't say it. Every billing or treatment entry links to its source page.
Medical Records OCR
Every format read — scanned claim files, faxed billing records, handwritten notes.
Medical record Q&A
Question the whole file in plain English — "any entry matching this billing pattern?" — every answer cited.
Claims integrity record review, answered.
This lane also covers the record review behind No Surprises Act IDR support and Medicare audit response — TPE, UPIC, SMRC, RAC, and ADR. See the provider fraud case-type page →
Build one cited file with it.
AI organizes and cites the record. The determination stays with you.