Insurance Solutions
Insurance Claim Analysis & Review
Make faster, more accurate claim decisions with expert medical record review and clinical insight. From health and disability claims to life and liability insurance, we help carriers adjudicate confidently, without overloading in-house teams.
500K+
Insurance Claims Reviewed Annually
150+
Insurance Carriers Supported
99.8%
Review Accuracy Rate
24-48 hrs
Average Review Turnaround
Challenges in Insurance Claim Review
Insurers must balance speed, accuracy, and compliance with fewer clinical resources
Complex Medical Necessity Reviews
Evaluating treatments against established medical guidelines and policy coverage requirements.
Pre-Existing Condition Analysis
Separating new injuries from prior conditions while assessing eligibility and coverage impact.
High-Volume Claim Processing
Reviewing thousands of claims each month without delays or making inconsistent decisions.
Detecting Fraud & Billing Risks
Spotting billing issues like upcoding, unbundling, duplicate charges, and unnecessary procedures.
One-Stop Insurance Claim Solutions
Precise Medical record review services built for insurance carriers and TPAs
Utilization Review
Assessing medical necessity and reasonability of treatments at different stages, such a sprospective review (before treatment), concurrent review (during treatment), or retrospective review (after claim submission).
Guideline-aligned evaluations
Evidence-based decision support
Policy-specific review
Independent Medical Record Review (IMRR)
Objective third-party medical record reviews to help insurers evaluate disability and life insurance claims, strengthen subrogation cases, support underwriting decisions, and manage complex claims accurately.
Unbiased clinical assessment
Causation analysis
Treatment appropriateness review
Pre-Authorization Review
Timely evaluation of the specific high-cost services, medications, or procedures needed for the patient to help the insurers confirm if they are covered under the claim and to provide prior approvals.
Rapid review turnaround
Evidence-based recommendations
Coverage determination support
Medical Bill Review & Audit
Thorough billing analysis to identify abnormal billing patterns, coding errors, unnecessary procedures, excessive charges, and indicators of fraud in medical claims, ensuring accurate reimbursement.
CPT/ICD code validation
Duplicate charge detection
Payment accuracy review
Multiple Product Lines
Insurance Claim Types We Support
Clinical expertise across all major insurance product lines
Health Insurance
Medical Necessity Reviews
Pre-Authorization Determinations
Claims Appeals
Policy Coverage Analysis
Experimental Treatment Review
Disability Insurance
Short-Term Disability (STD)
Long-Term Disability (LTD)
Functional Capacity Assessment
Return-to-Work Evaluation
Residual Functional Capacity
Life Insurance
Medical Record Underwriting
Contestability Reviews
Accelerated Underwriting Support
Risk Assessment
Mortality Analysis
Liability & Auto Insurance
Injury Assessment
Treatment Appropriateness
Causation Analysis
Future Medical Projections
Subrogation Support
Why Insurance Carriers Rely on Us
We deliver objective, guideline-based medical reviews that improve claim accuracy and turnaround times. We help teams scale efficiently while maintaining compliance and consistency.
Professional support across 50+ specialties to handle all types of insurance reviews
Scalable review support for consistent adjudication across teams and regions
Reduced inappropriate payouts through rigorous medical necessity analysis
24/7 customer support via chat or call ensuring hassle-free communication
Early identification of fraud, upcoding, unbundling, and billing inconsistencies
Real-time updates on case review processes through our CaseDrive platform
Licensed RN/Physician Reviewers
InterQual/MCG Certified
Utilization Management Experience
HIPAA & SOC 2 Compliant
Insurance Claims Success Story
Regional Health Insurance Carrier
8,000 Monthly Claims
Challenge
Health insurer processing 8,000 claims monthly faced 7-10 day delays in medical necessity determinations due to limited in-house clinical staff. Appeal rates were increasing due to inconsistent adjudication decisions and lack of specialist expertise for complex cases.
Solution
Deployed scalable medical review team providing 24-48 hour turnaround for standard claims, specialist reviewers for complex cases, and standardized medical necessity protocols aligned with clinical guidelines and policy criteria.
Results Achieved
65%
Reduction in review turnaround time
8,000
Claims reviewed monthly
32%
Decrease in appeal rates
$1.2M
Annual operational savings
Frequently Asked Questions
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