Pre-BILL Claim Review

medical claim review

Our medical claims review team is composed of  U.S. certified physician reviewers who analyze medical records to ensure all billable diagnoses and procedures are captured and coded following the most up-to-date clinical and coding guidelines.

Their training allows them review charts from a clinical view, to quickly identify opportunities to maximize coding and engage hospital physicians through the creation of physician queries.

  • DRG Review - Day 1 Impact
  • Mitigate Risk of Denials
  • Review Medicare, Medicare Advantage, and Commercial Claims

Ensure Accuracy & Compliance

Pre-Bill Medical Claim Review by Experienced U.S. Trained Physicians

  • MSDRG assignment
  • APRDRG assignment
  • Quality Reviews:
    • Risk of Mortality
    • Severity of Illness
    • Hospital-Acquired Conditions
    • Patient Safety Indicators
    • Present on Admission conditions
  • Data Analysis and Reports, including identification of coding and documentation trends that affect reimbursement.
  • Creation of physician queries
  • Appeals of medical necessity denials, coding denials, and clinical validation denials.
  • Custom Consulting:
    • Physician engagement and collaboration with coding and CDI staff, including case discussion and training as requested
    • Revenue projections and valuations of practices or service lines


(200 – 250 Claims) or 90-day Review

Claim review