Smart Bill Audit.
Catch Overcharges.

Enforce Clinical Documentation Request

Check this to include a formal demand for Progress Notes and Operative Reports in your dispute letter. Highly effective for high-value surgery and inpatient charges.

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Request your Itemized Bill (UB-04/HCFA-1500). Hospitals are legally required to provide this under CMS guidelines.

Upload the PDF. Our engine reconstructs every line item into a searchable clinical grid for integrity checks.

Spot 🔴 Red Flags. If a service violates MUE or NCCI rules, it's a "deterministically invalid" charge.

Generate the Professional Dispute Letter. It includes the exact clinical citations needed to win an appeal.

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📊 The Confidence Score

This overall percentage (0-100%) represents the technical integrity of the audit. A higher score means we had better data to work with.

• CPT Coverage: Every line item has a valid medical code.
• Benchmark Hits: We successfully matched pricing against Medicare registries.
• Date Integrity: All services are correctly sequenced in time.

🩺 Verified Provider Identity

We cross-reference every NPI number against the federal registry (NPPES). This card tells you:

• Taxonomy Check: Is a Psychiatrist billing for a Heart Surgery? (Specialty Mismatch).
• Location Integrity: Is the provider practicing outside their registered region?

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🔴 NCCI Bundling Audit

Flags "Unbundling"—the illegal practice of billing for the parts of a procedure when a single "comprehensive" code covers the entire service. This is one of the most common overcharges in surgery.

🔴 Frequency Audit (MUE)

"Medically Unlikely Edits" are federal limits on how many times a service can result in a valid charge for a single patient in 24 hours. (e.g. billing for two Appendix removals).

🟡 Modifier Accuracy

Detects missing surgical discounts. For example, if two procedures are done in one visit, the second should have a -51 modifier (50% discount). Hospitals often "forget" this.

🟢 Benchmark Pricing

Compares your bill to Transparent Medicare Benchmarks. If a hospital bills $5,000 for a test that Medicare pays $200 for, we flag the 2,500% markup as unreasonable.

Self-Pay (1.5x) The gold standard for the uninsured. Based on "Fair Health" cost-to-charge ratios.

Commercial (2.5x) The standard "Market Rate" allowed by most high-quality insurance networks.

Worker's Comp (3.0x) Legal maximums often found in statutory liability or specialist injury claims.