# Claims Review for Self-Insured Programs — Medrecords AI > Every dollar of leakage comes off your own book. Standardize review, hit stop-loss and SIR deadlines, and keep the audit trail your carrier needs. Canonical page: https://medrecords.ai/solutions/self-insurers/ --- New — **Missing Records Detection:** flags every visit, provider, and date missing from the file. [See how →](https://medrecords.ai/product/missing-records-identification/) [Home](https://medrecords.ai/) ›[Solutions](https://medrecords.ai/) › — Self-Insurers Medical record review for self-insured programs ## You kept the risk. Keep the margin too. For self-insured programs, Medrecords AI turns the claim file around fast enough to hit stop-loss reporting deadlines and cites it well enough to defend at renewal — with a team no bigger than it needs to be. When the excess carrier or the auditor asks, the file answers, every finding traced back to its source page. [Book a demo](https://medrecords.ai/demo/) [Estimate Your ROI ](https://medrecords.ai/plans/self-service/) Claim #SI-2091 · reserve review stop-loss ready Claim opened — SIR tracking starts — logged Claim summary cited · 9 sources — per finding Incurred crosses $250k SIR line — flagged Excess carrier packet assembled — same day Audit trail complete end to end — complete When the excess carrier or the auditor asks, the file answers The status quo Self-insured programs carry the risk directly. No carrier spreads the cost of a slow review or a missed reserve. Manual review stays expensive precisely where the margin is thinnest, *and every dollar of leakage comes straight off your own book.* no risk pool to spread a slow review across the SIR line cross it and the excess carrier wants the file 1 reviewer, often doing a claims floor's job ### Get the defensible claim file — without assembling it yourself. Everything a determination needs: structured, surfaced, and sourced. Medrecords organizes the file, flags what inflates the claim, and builds summaries backed by citations, so adjusters decide instead of dig. Claim summary · auto-drafted p.31 p.212 p.640 #### Summaries: the whole claim in one view A complete, structured summary per claim (mechanism of injury, treatment to date, and disputed charges), every finding traced back to the page it came from. Chronology · by date Feb 11 — Date of injury — incident report Apr 02 — Progress Note May 22 — Gap in care · 47 days, no treatment Jun 01 — Billing statement — CPT 99214 Jul 17 — Consultation Report #### Automated chronology: the claim in order Every page placed by date, provider, and event, with treatment gaps and billing anomalies flagged inline. Scroll the claim instead of hunting through PDFs. Duplicate sets · 4 — Match similarity Billing Statement — multiple — Review Consultation Report — 84% — Review Wrong claimant — J. Roe — co-mingled — Separate Remove all duplicates #### Indexing & dedup: a clean, searchable file Medrecords removes duplicate pages, flags mismatches, and separates co-mingled claimants — so the file behind the determination is one you can trust. PHI audit trail · live — Claim #SI-2091 09:14 · A. Rivera viewed p.212 — ✓ 09:16 · A. Rivera exported claim summary — ✓ 09:31 · Dr. Chen reviewed flagged charges — ✓ 09:47 · QA verified diagnosis fields — ✓ 10:02 · Determination note added to file — ✓ #### Audit trail: defensible by design Every access logged, case-level minimal access enforced, and every finding cited to its source — a file that stands up to audit, dispute, and regulator alike. Adapts to each claim ### Built for the risk you carry yourself. When you retain the risk, review has to earn its keep. Medrecords gives a lean team the same structured, cited file a full claims floor would produce. 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 record — by provider · date 01 — Jul 17 — Medical Records 02 — Jul 17 — Billing Statements 03 — Aug 06 — Physician Notes 612 pp indexed · every row cited — open the case → #### Catch the SIR line before it catches you Files organized and summarized fast enough to flag a claim crossing into excess before the reporting deadline does. #### One standard, any headcount The same structured, cited file whether the team is one adjuster or 10 — so self-administered claims hold up at renewal, at audit, and at the board. Who this is for ### The risk sits on your balance sheet. The busywork doesn't have to. Self-insured employers and funds run claims like an internal department — lean, accountable, and directly exposed to every dollar of leakage. Medrecords gives that team a defensible, cited file without the headcount of a full carrier claims floor. Reserve and SIR tracking backed by a cited file, not a hunch Excess and stop-loss reporting packets assembled same day One defensible standard, whether the team is one person or 10 Program status · self-administered on reserve Findings cited — 9 sources attached — per finding Reserve reviewed against the file, not a hunch — verified SIR threshold tracked automatically — flagged $250k Excess carrier packet — assembled in minutes — ready Ready for the excess carrier, the auditor, or the board The objection ### "Will this hold up when our excess carrier — or our regulator — comes asking?" Deployment options, PHI audit logging, retention controls, and BAA/DPA availability, stated plainly on a page your risk manager or broker can bookmark and forward. Diligence first; the demo can wait for the paperwork. [Request the security package ](https://medrecords.ai/security/) Who we serve ### One 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 [ — IME Physicians — Defensible IME opinions, faster](https://medrecords.ai/solutions/medical-evaluators/) [ — Claims Adjusters — Triage and settle sooner](https://medrecords.ai/solutions/insurance/) [ — Defense Lawyers — Surface the case-deciding fact](https://medrecords.ai/solutions/legal/) [ — Legal Nurse Consultants — Chronologies in a fraction of the time](https://medrecords.ai/solutions/legal-nurse-consultants/) [ — Expert Witnesses — Cited opinions, not paper chases](https://medrecords.ai/solutions/expert-witnesses/) [ — Life Care Planners & Vocational Experts — Cost projections built on the full record](https://medrecords.ai/solutions/life-care-planners/) [ — Social Security Disability Representatives — Years of records, one hearing](https://medrecords.ai/solutions/disability-representatives/) [ — Forensic Psychological Evaluators — Your report format, fully cited](https://medrecords.ai/solutions/forensic-psychological-evaluators/) Organizations [ — Insurance Carriers — Scale review across every claim](https://medrecords.ai/solutions/insurance-carriers/) [ — Law Firms — Litigation-ready case files](https://medrecords.ai/solutions/law-firms/) [ — TPAs & Case Management — Standardize across clients](https://medrecords.ai/solutions/tpas/) [ — Government & Public Sector — Compliant, auditable records](https://medrecords.ai/solutions/government/) [ — IME Companies & Networks — One pipeline, every physician](https://medrecords.ai/solutions/ime/) [ — Self-InsurersYOU ARE HERE — Claims reviewed like a carrier would](https://medrecords.ai/solutions/self-insurers/) [ — Disability Insurers — LTD/STD files, cited every cycle](https://medrecords.ai/solutions/disability-insurers/) [ — Settlement Administrators — Tier claims at MDL scale](https://medrecords.ai/solutions/settlement-administrators/) [ — VA C&P Exam Contractors — C-files, exam-ready on time](https://medrecords.ai/solutions/va-cp-contractors/) [ — Hospital Risk Management — Know the chart before counsel does](https://medrecords.ai/solutions/hospital-risk-management/) [ — Litigation Funders — Underwrite the file, not the pitch](https://medrecords.ai/solutions/litigation-funders/) [ — Medical Funders & Lien Networks — Fund the treatment, verify the file](https://medrecords.ai/solutions/medical-funders/) Use Cases [ — Social Security Disability — Timeline ready before the hearing](https://medrecords.ai/solutions/social-security-disability/) [ — Personal Injury Plaintiff — Cited evidence on demand](https://medrecords.ai/solutions/personal-injury-plaintiff/) [ — Personal Injury Defense — Verify specials, flag the gaps](https://medrecords.ai/solutions/personal-injury-defense/) [ — Veteran Disability — Timeline built before the exam](https://medrecords.ai/solutions/veteran-disability/) [ — Workers' Compensation — Track treatment and gaps](https://medrecords.ai/solutions/workers-comp/) [ — Mass Tort — Qualify claimants at scale](https://medrecords.ai/solutions/mass-tort-case-review/) [ — Medical Malpractice — Reconstruct the timeline](https://medrecords.ai/solutions/medical-malpractice/) [ — Auto Bodily Injury Claims — Specials and causation, cited](https://medrecords.ai/solutions/bodily-injury-claims/) [Not sure which fits? Talk to us about Enterprise ](https://medrecords.ai/demo/) ### Benchmark one reserve file. Run 30 claims. Compare turnaround and findings against what your team spends today. [Book a demo](https://medrecords.ai/demo/) [Test a file ](https://medrecords.ai/test-a-file/?src=solutions-self-insurers) ### More solutions - [**1,000 pages of EHR export arrive as one APS file. The disclosure that matters is somewhere inside.** — APS files, life expectancy records, and contestability files organized and cited against the carrier's own…](https://medrecords.ai/solutions/life-disability-underwriting/) - [**1,200 pages, 5 providers, one mortality multiplier.** — Medical record review for life expectancy underwriting. Impairment extraction, condition progression…](https://medrecords.ai/solutions/life-expectancy-underwriting-review/) - [**1,500 pages of c-file, read before the examiner opens it.** — C-file review for VA examination providers, accredited agents and VSOs. Service treatment and private records…](https://medrecords.ai/solutions/va-c-file-review/) - [**120 days from the answer. Dismissal with prejudice if you miss.** — Page-cited record review for Texas §74.351 expert reports — the file read in full before your expert writes, at…](https://medrecords.ai/solutions/texas-certificate-of-merit/) - [**182 days of notice. Then the affidavit files with the complaint.** — Page-cited record review for Michigan MCL 600.2912d affidavits of merit — the file read in full inside the…](https://medrecords.ai/solutions/michigan-certificate-of-merit/) - [**2 of 6 activities of daily living for 90 days — or severe cognitive impairment.** — Record review for long-term care insurance benefit eligibility and recertification. ADL and cognitive…](https://medrecords.ai/solutions/ltc-benefit-eligibility-review/)