Clinical Review & Audits
Retrospective and concurrent reviews by clinicians and certified nurse auditors to validate medical necessity and coding accuracy.
Medical Review, Clinical Audits & Repricing
Evidence-driven clinical review, utilization management and repricing services that reduce unnecessary spend, ensure compliance, and improve the quality of care.
Audit‑ready
Documentation & defensible findings
30%+
Average cost recovery on repricing projects
Flexible
On‑demand teams or long‑term engagements
Utilization Management
Evidence-based utilization reviews, prior authorization support, and discharge planning alignment to control costs and improve outcomes.
Repricing & Cost Recovery
Comprehensive repricing engagements including DRG/unbundling corrections and payer negotiations to recover improper payments.
How our medical review works
We combine clinical expertise, coder review and analytics to produce audit-ready findings. Our process is designed to be transparent, defensible, and aligned with payer rules.
- Scope & Intake: Samples, claim extracts, and clinical records to define project scope and KPIs.
- Clinical Review: Nurse/physician reviewers evaluate medical necessity, documentation quality and coding alignment.
- Repricing & Recovery: Where appropriate, repricing models are run and recovery opportunities are pursued with payers.
- Reporting & Remediation: Actionable reports, policy recommendations and training to close gaps.
Long description to attract clients
Payers, providers and employers rely on careful clinical review to ensure that care delivered is appropriate and documented — and that payments reflect the services provided.
Beyond single-case reviews, our analytics-driven approach identifies systemic trends — documentation gaps, coding patterns, or utilization outliers — and gives you prioritized remediation steps.
Engage us for a focused pilot to evaluate claims from a specific period or service line; we’ll return a concise findings report, estimated financial opportunity and an operational plan to address root causes.