Claims adjudication support, cited line by line.
Insurance claims software for cited adjudication support: triage, billing verification, fraud signals, and relatedness tagging — twenty-one claims-side capabilities that document everything and decide nothing. The adjudicator always signs off on the decision, and all twenty-one capabilities are included in every subscription, at one flat rate.
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.
Bulk-processes claim portfolios against your criteria; only claims needing human judgment reach a human.
ExploreEvery billed amount traces to a source page — click any dollar figure, land on the document that justifies or contradicts it.
ExploreBilling roll-ups and future-care cost tables, ready for life-care plans and specials.
ExploreTracks outstanding record requests with tiered follow-up escalation and a full audit trail.
ExploreChecks every diagnosis, treatment claim, and billed figure in an incoming demand against the record behind it.
ExploreOne-page rolled-up billing summary, grouped by provider/date/category, from the ledger's source-verified data.
ExploreFlags intra-record contradictions and cross-claim provider patterns (cloned notes, upcoding signals) — cited signals for SIU review, not accusations.
ExploreCompares every billed amount to UCR/geographic benchmarks and flags outliers with percentile context.
ExploreTags each visit and charge as related/unrelated/disputed to the covered incident, cited — adjudicator signs off.
ExploreDrafts the WCMSA allocation from the record at Medicare fee-schedule rates — ready for a certified MSA specialist's sign-off.
ExploreParses demanded actions, deadlines, policy requests, allegations, injuries, treatments, and billing assertions into cited fields ready for verification.
ExploreScans the record for signals of third-party liability, duplicate coverage, and Medicare, Medicaid, or ERISA recovery opportunities, flagged for your recovery team.
ExploreOne platform underneath.
Claims work starts with a clean file and cited answers. These groups sit underneath every flag.
Run one 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.