Claims adjudication support, cited line by line.
Insurance claims software for cited adjudication support: triage, billing verification, fraud signals, and relatedness tagging — ten claims-side capabilities that document everything and decide nothing. The adjudicator always signs off on the decision, and all ten 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.
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.