Claim auditing platform

Audit every claim.
Not a sample.

AudiClaim takes your claim feeds from intake to recovery: every line is run against your audit rules and current CMS reference data, and every finding is carried through review, submission, and recovered dollars — in one platform.

See how it works

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The whole platform, intake to recovery

Spec-driven audit rules written by AI, the built-in CMS fee schedules, full-text claim-document search, and findings tracked as cases through to recovered dollars.

100%

of claims audited on every run — never a sample

19

CMS reference datasets built in and kept current

200+

curated code dictionaries ready to use in rules

1

platform from claim intake to recovered dollars

How it works

One pipeline, beginning to end

No hand-offs between an intake tool, a query team, and a spreadsheet. A claim enters once and leaves as a tracked recovery.

  1. Step 1

    Ingest

    Claim batches arrive over SFTP or direct upload. Parsing, validation, and versioning are automatic — a re-submitted claim supersedes its prior version, so nothing is ever double-counted.

  2. Step 2

    Audit

    Every claim line runs against every active rule. Rules are written as plain-language specs — the engine compiles and executes them against the full claim pool. No SQL. No scripts.

  3. Step 3

    Review

    Findings become cases in a queue built for auditors: record locking against double work, notes and attachments, and dispositions that require a written, immutable reason.

  4. Step 4

    Recover

    Submit confirmed overpayments, generate claim letters, and track recovered dollars by rule, client, and auditor — the numbers your clients actually ask for.

Platform

Everything an audit shop runs on

Streamlined audit engine

Write the audit logic once as a spec; the engine compiles it and runs the entire claim pool — including cross-claim correlations like services billed during an inpatient stay.

Integrated fee schedules

Medicare PFS, NCCI, MUE, OPPS, ASC, CLFS, DMEPOS, ASP and more — loaded, kept current, browsable in-app, and directly addressable from any audit rule.

Claim data extractor

Full-text search across every claim document — born-digital or scanned, OCR included — with a downloadable audit report of every match.

Curated code dictionaries

200+ maintained groups of procedure, diagnosis, revenue, and modifier codes, ready to drop into a rule — plus dictionaries you define per client.

Case management for auditors

Locking prevents two auditors from working one case; terminal statuses are one-way; every reject or terminate carries a written, immutable reason.

Reporting & analytics

Excel run reports, KPI dashboards, rule performance, auditor productivity, and recovery tracking — every number traceable back to the claim line.

Reference data

The fee schedules are already in the building

Most audit tools make reference data your problem — download the quarter's files, stage them, hope the joins line up. AudiClaim ships with the CMS datasets loaded and maintained, browsable next to your claims, and addressable from a rule the same way you'd name a code list.

When a rule says “paid above the fee schedule,” it means the fee schedule that was in force — editions are tracked, not overwritten.

Medicare Physician Fee ScheduleNCCI Procedure-to-Procedure EditsMedically Unlikely Edits (MUE)OPPS (Hospital Outpatient)ASC Payment RatesClinical Lab Fee ScheduleDMEPOS Fee ScheduleASP Drug PricingMS-DRGAnesthesia Base UnitsAmbulance Fee ScheduleSNF PPSHome Health PPSICD-10-CMHCPCS Level IINDC DirectoryState Workers' Comp SchedulesZIP-to-Locality Mapping

Claim data extractor

Ask your claim files a question

The answer an audit needs is often inside the attachments — the operative report, the itemized bill, the progress notes. The extractor searches every claim document for the words and phrases you care about, whether the file was born digital or scanned, and hands back a downloadable report of every hit with its source.

No more opening PDFs one at a time to find out whether the documentation supports the code.

Security & compliance

Built for PHI from day one

Claim data is protected health information, and the platform is built around that fact — not retrofitted for it.

  • Hosted on AWS under a signed Business Associate Agreement

  • Strict per-client data isolation, enforced at the query layer

  • Role- and module-based access; sessions in HttpOnly cookies, never in page scripts

  • A complete audit trail — every view, change, and disposition is attributable

See it run on real claims

A demo is the fastest way to judge an audit platform — watch a batch go from intake to findings, then take the run report with you.

Use Request a demo in the header, or write to us at .