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Medical record review for claims

Cut review time and leakage — with an audit trail.

Upload the claim file. Get the cited summary, chronology, and flagged findings before your first read — every determination documented for the file.

Claim #48-2214 · first read flags
$473 flagged across 3 findings — all cited
Duplicate CPT 99213 — billed twicep.312 · p.318
Treatment gap — 6 weeks, no documented carep.212
Prior injury undisclosed — 2019 lumbar strainp.31
Summary & chronology ready for determinationcited
Every determination documented for the file
The status quo

Adjusters inherit claim files thousands of pages deep — records, bills, statements. Manual review drags out every determination, and it's exactly where leakage slips through unnoticed.

40+
open files on your desk Monday
3
new packets in the queue
1
reserve review due Friday

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 11Date of injury — incident report
Apr 02Progress Note
May 22Gap in care · 47 days, no treatment
Jun 01Billing statement — CPT 99214
Jul 17Consultation 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 · 4Match similarity
Billing StatementmultipleReview
Consultation Report84%Review
Wrong claimant — J. Roeco-mingledSeparate
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 · liveClaim #48-2211
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 claims determinations.

You shouldn't have to patch together PDFs, bill review spreadsheets, and adjuster notes to settle a claim. Medrecords gives you one structured, auditable view — ready for the determination.

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 1 DICOM study
Organized recordby provider · date
01Jul 17Medical Records
02Jul 17Billing Statements
03Aug 06Physician Notes
612 pp indexed · every row citedopen the case →

Triage the queue, not just the file

Configurable workflows sort, route, and prioritize claims documents automatically — so every adjuster opens a file that's already organized, and the complex claims surface first.

Standardize review across every desk

The same structured, cited output on every claim — across adjusters, offices, and TPAs. Expert-verified before it reaches the desk, consistent enough to audit.

Who this is for

You have 40 open files. Reserves are due Friday.

Adjusters live between the queue and the deadline. Medrecords does the first read on every file — triage takes minutes, the red flags come to you, and the determination is defensible on the first pass.

Prior injuries and pre-existing conditions identified up front
Initial file review cut from days to hours
Cleaner pre-work that cuts downstream IME and legal spend
Your queue · Friday 09:00 reserves due
#48-2211 — Summary ready, all findings citeddone
#48-2214 — 2 flags · unsupported charges $12,480review
#48-2216 — Deduped 1,847 → 612 pages−67%
#48-2219 — Gap in care flagged · 47 daysp.212
Triage done first thing — every flag sourced
The objection

"Will this hold up if the file gets audited or litigated?"

Every finding is traceable to its page; every PHI access is logged. The audit trail isn't a feature bolted on for compliance — it's the product. Your file notes cite the same sources the auditor sees.

60% less first-read time in the pilot

"The flags queue changed my mornings. I open files that are already triaged — and every flag has a page number I can put in my notes."

Senior claims adjuster · regional carrier, Midwest

Run one claim file through it.

Pick your messiest open file. See what it flags — and what the flags cite.