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Medical record review for UR & peer review teams

One necessity determination. Every reviewer, same standard.

Medical record review for utilization review and peer review teams: treatment history organized and cited against clinical criteria before the determination is due, so medical necessity decisions hold up on appeal. Built for UR nurses and physician reviewers at carriers, TPAs, and independent review organizations, working the record and the criteria to a deadline.

By Ahmed Jemaa, Co-Founder & CEO of Medrecords AI · Published 29 Aug 2026 · Updated 14 Sep 2026Summarize with ChatGPT, Claude, Perplexity or Google AI

UR request · organizing review-ready
280 pp → 3 providers, sorted & deduplicated
Treatment-to-criteria match: cited to guideline & page
Conflicting diagnosis codes: flagged across providers
Built for the whole queue, not 1 file at a time.
The status quo
same file, different reviewer, different answer
turnaround measured in hours under URAC/state deadlines
one uncited denial is an appeal waiting to happen

How fast is turnaround on a standard UR request?

Medrecords AI is built for same-day; exact turnaround depends on file size: ask for a benchmark on your typical file.

Open a review packet that's already organized.

Everything the determination needs: structured, surfaced, and sourced. Medrecords organizes the request and the records behind it, builds the treatment timeline, and drafts the history with citations, so your time goes to the criteria and the determination.

UR / peer review · from your templateYour template
p.31 p.212 p.640

Custom reports: your letterhead, your voice

Summary templates draft the history and the criteria review with inline citations. You add the determination. Export clean, in your format, every time.

Chronology · by date
2019Prior injury · lumbar strain, pre-DOI
Feb 11Date of injury: ER visit
May 22MRI: Lumbar imaging placed inline
Jun 01Gap in care · 47 days
Jul 17Orthopedic consultation

Automated chronology: the history in order

Treatment history, criteria evidence, and gaps: every event dated, sourced, and in sequence. The whole request scannable before the determination is due.

Duplicate sets · 4Match similarity
Ambulance Call ReportmultipleReview
Consultation Report84%Review
Progress Note87%Review
Remove all duplicates

Dedup & indexing: shrink the request first

Review packets arrive bloated with duplicates and misfiled pages. Medrecords removes the redundancy and indexes what remains, so you read each page once.

Cross-checked · multi-modelCase #M-2210
Claimant nameJane Doe✓
Date of injury2024-02-11✓
DiagnosisLumbar disc herniation✓
Prior injury2019 lumbar strain✓
Treatment to datePT ×12 · ESI ×2✓

Built to be checked, page by page

Multiple models cross-check every extraction. Each field carries its citation and a confidence score, and low-confidence pulls are flagged, so your verification is a click, not a re-read.

Rerun 1 decided UR file against your own answer.

Send 1 UR or peer review file your team already decided. We build the page-cited treatment timeline, and you compare it line by line with the determination you already made. If we miss something, you see it on a file you know.

Built for expert-level decisions.

Contradictions, diagnostic inconsistencies, prior injuries: surfaced with citations, scored for confidence, and left for you to weigh. The judgment stays yours.

Intake · Case 2025-0412 reading: p. 1,462 / 1,847
PDF ED_records · 214 pp DOC ortho_chart · 1,128 pp JPG nurse_note · flagged
Multi-model read · dedupe · claimant split · index
1,847 pp in 612 unique 14 flagged One DICOM study
Organized recordby provider · date
01Jul 17Medical Records
02Jul 17Imaging Reports
03Aug 06Physician Notes
612 pp indexed · every row citedopen the case →

Surface the clinical details that change opinions

Contradictions across providers, diagnostic inconsistencies, and key clinical events: highlighted on the timeline and cited to the page, so you analyze instead of search.

We help you make the call. The last word is yours.

AI does the reading, every line stays reviewable and traceable, and verification is 1 click to the source. The findings and the opinion remain yours. As they should.

You're the expert. Reading shouldn't be the job.

UR nurses and physician reviewers at carriers, TPAs, and independent review organizations who justify a necessity decision against the record and the criteria, on a deadline.

Contradictions and diagnostic inconsistencies highlighted with sources
Records oriented by provider, facility, and date at a glance
More files per week, with the same clinical rigor
Records review · file 3 of 9 today panel-ready
Dx: cervical radiculopathy: progress notep.212
EMG negative: 6 weeks laterconflict · p.388
Prior claim, same body part: 2021p.63
ROM measurements: all visits, comparedtable
Contradictions found for you: conclusions stay yours

"Does this make the medical necessity call for us?"

No. It lines up the treatment record against your criteria and cites every match or gap. The determination, and the signature on it, stays yours.

Built for the defensible determination.

A single platform, built for everyone who works the file.

The same defensible, cited record, shaped to how each team reads it: the case, the claim, or the exam.

Roles
Plaintiff AttorneysProve the injury, dollar by dollar Defense CounselSurface the case-deciding fact Legal Nurse ConsultantsChronologies in a fraction of the time IME & QME PhysiciansDefensible IME opinions, faster Medical Expert WitnessesCited opinions, not paper chases Claims Adjusters & ExaminersTriage and settle sooner Forensic EvaluatorsYour report format, fully cited Medical Examiners & CoronersThe history before the certification Life Care Planners & Vocational ExpertsCost projections built on the full record VA-Accredited RepresentativesThe whole C-file before you file C&P ExaminersC-files, exam-ready on time Social Security Disability RepresentativesYears of records, 1 hearing
Organizations
Insurance CarriersScale review across every claim Law FirmsLitigation-ready case files TPAs & Case ManagementStandardize across clients Government & Public SectorCompliant, auditable records IME Companies & NetworksOne pipeline, every physician Self-InsurersClaims reviewed like a carrier would Disability InsurersLTD/STD files, cited every cycle Settlement AdministratorsTier claims at MDL scale VA C&P Exam ContractorsC-files, exam-ready on time Hospital Risk ManagementKnow the chart before counsel does Litigation FundersUnderwrite the file, not the pitch Medical Funders & Lien NetworksFund the treatment, verify the file
Use Cases
Social Security DisabilityTimeline ready before the hearing Personal Injury PlaintiffCited evidence on demand Personal Injury DefenseVerify specials, flag the gaps Veteran DisabilityTimeline built before the exam Workers' CompensationTrack treatment and gaps Mass TortQualify claimants at scale Medical MalpracticeReconstruct the timeline Auto Bodily Injury ClaimsSpecials and causation, cited
Not sure which fits? Talk to us about Enterprise

Peer Review & Utilization Review, answered.

Yes. Criteria sets are configurable per client and cited the same way as the medical record.

Built for same-day; exact turnaround depends on file size: ask for a benchmark on your typical file.

Yes. The record read is the same; only the question being asked changes.

Send your next UR file.

Read the determination-ready summary. Then decide.

Sources

Every rule, regulation, statute and published standard named on this page is linked below to the text the body that issues it puts out, read on the date shown. Where a standard is sold rather than published, the link goes to its publisher's page for it. A few rules are named without a link, because no source we could read and confirm publishes them.

Related guide: Medical chart audit: how to run one that holds up

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