Approach
Contextual, human-directed review
PreBill Audit is designed to support how hospital teams already work: by reviewing claims in context, surfacing potential risks clearly, and leaving all decisions in human hands.
What "contextual review" means
In many systems, claim review is performed using isolated checks — individual rules applied without regard to the surrounding details. Contextual review takes a different approach.
Contextual review means that a claim is examined by looking at the full picture: how diagnoses, procedures, modifiers, and documentation relate to one another, rather than evaluating each element in isolation.
For example, instead of flagging a combination simply because it appears together, the review considers whether the documentation and coding intent appear aligned — and highlights situations where that alignment may be unclear or worth a second look.
Clear findings, not hidden logic
When potential risk is identified, the system presents a concise explanation describing why the situation may warrant attention. Each finding includes supporting references so staff can verify the rationale quickly.
The goal is not to replace judgment, but to make review more efficient by focusing attention on claims that may benefit from a second look.
Plain-language rationale
Concise explanation of what triggered review and what to verify.
Supporting references
Linked citations so staff can validate the reasoning.
Prioritized output
Findings organized by category and practical review urgency.
Designed for existing workflows
PreBill Audit is intended to run alongside existing QA, edit, and review processes as an additional review layer. It does not interrupt established workflows or require changes to how coding or compliance teams operate.
Findings are presented for review at a point where staff still have time to assess, clarify documentation if needed, and proceed confidently.
Clear boundaries and human authority
Outputs are advisory only. The system does not assign codes, modify claims, or submit anything on behalf of the hospital.
Staff remain the final authority on all coding and submission decisions. PreBill Audit exists to support that authority by providing consistent, well-explained insight — not to override it.
Local control
Deployment is designed for hospital-controlled environments, supporting data governance requirements and internal oversight. Claim data remains under the hospital’s control throughout the review process.