The bill says 41 units. The chart has to show them.
Payment integrity clinical review services read an itemized bill against the chart behind it and cite the documentation for every billed line. Charges with no supporting record are flagged, and the medical necessity determination stays with the payer's clinical reviewer and medical director.
The criteria are published. So is the reviewer who applies them.
We do not build for a case type until we can name the standard that defines a correct output and the person who grades the file against it. In payment integrity review, both are already published.
3 steps between the bill and the determination.
Send the bill and the chart
The itemized bill and the full clinical record behind it, in any format and any order.
We return the audit, page-cited
Each billed line matched to the documentation supporting it, the criteria elements located in the chart, and every charge with nothing behind it flagged in its own line.
Your medical director determines
Medical necessity, coverage, and the payment decision are the plan's, made by a clinician under the plan's own criteria. We never deny, approve, or price a claim.
Evidence for the reviewer, never the coverage decision.
We reconcile the billed lines against the chart and cite what supports each one. We do not determine medical necessity, deny or approve a claim, apply a coverage exclusion, or calculate a payment. Every one of those is a plan determination made by a qualified clinical reviewer, and the appeal rights that follow attach to that person's decision, not to ours.
The audit runs in both directions. A billed line the chart clearly supports is called out as supported, because a payment integrity program that only ever finds overpayments is the one that loses on external appeal.
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.
4 capabilities behind every bill audit.
The bill audit is 1 deliverable of the same platform that reads, sorts, and cites the whole record.
Medical Records OCR
Every page read in full — itemized bills, MAR sheets, implant logs, operative notes, handwritten flowsheets — nothing skipped, nothing guessed.
Medical Chronology
The admission builds itself into a timeline, so a billed service can be placed against the hour it was supposedly delivered.
Verifiable AI Citations
If we can't cite it, we don't say it. Every billed line in the audit links to the chart page that documents it, or is flagged as unsupported.
Medical Summary Reports
The audit formats straight into the review file — your template, your letterhead.
Payment integrity review, answered.
Send 1 file. We'll tell you what we can read.
No obligation. If the case type is buildable we'll scope it; if it isn't, we'll say so.