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Medical record review for carriers

Scale defensible review across every claim in the book.

Medrecords standardizes medical review across lines, desks, and regions — faster determinations, less leakage, and a PHI audit trail on every file.

Flags Summary Timeline Audit Claim #48-2211 · 1,847 pp
Findings flagged for review
Gap in care — 47 daysp.212
Unsupported charge — CPT 99214 billed twicep.640
Inconsistent injury history across providersp.88 · p.412
Prior injury disclosed — 2019 lumbar strainp.31
Every access logged · PHI audit trail
Charges flagged
$0
across 3 findings · all cited
Source · p.640100%

The status quo

Across a book of business, review quality varies desk to desk. Slow files inflate cycle time and reserves, and small leaks compound into material indemnity loss.

0
pages in a complex claim file
0 hrs
of review per claim — desk by desk
0 charge
missed compounds across the book

Get the defensible claim file — without assembling it yourself.

Everything a determination needs — structured, surfaced, and sourced. Medrecords organizes the file, flags what inflates the claim, and builds summaries backed by citations, so adjusters decide instead of dig.

Claim summary · auto-drafted

p.31p.212p.640

Summaries: the whole claim in one view

A complete, structured summary per claim — mechanism of injury, treatment to date, and disputed charges — every finding traced back to the page it came from.

Chronology · by date

Feb 11Date of injury — incident report
Apr 02Progress Note
May 22Gap in care · 47 days, no treatment
Jun 01Billing statement — CPT 99214
Jul 17Consultation Report

Automated chronology: the claim in order

Every page placed by date, provider, and event — with treatment gaps and billing anomalies flagged inline. Scroll the claim instead of hunting through PDFs.

Duplicate sets · 4Match similarity
Billing StatementmultipleReview
Consultation Report84%Review
Wrong claimant — J. Roeco-mingledSeparate
Remove all duplicates

Indexing & dedup: a clean, searchable file

Medrecords removes duplicate pages, flags mismatches, and separates co-mingled claimants — so the file behind the determination is one you can trust.

PHI audit trail · liveClaim #48-2211
09:14 · A. Rivera viewed p.212
09:16 · A. Rivera exported claim summary
09:31 · Dr. Chen reviewed flagged charges
09:47 · QA verified diagnosis fields
10:02 · Determination note added to file

Audit trail: defensible by design

Every access logged, case-level minimal access enforced, and every finding cited to its source — a file that stands up to audit, dispute, and regulator alike.

Adapts to each claim

Built for the book, not just the file.

Consistency is the carrier's edge. The same structured, cited output on every claim — measurable, auditable, and ready to scale.

01Jul 17Medical Records
02Jul 17Billing Statements
03Aug 06Physician Notes
PDF DOC JPG

Consistent output across every desk

Every adjuster starts from the same organized, cited file — so quality doesn't depend on who caught the claim, and audits read the same everywhere.

Leakage caught before it pays out

Treatment gaps, duplicate billing, and unsupported charges flagged with sources across the whole book — not discovered in the post-mortem.

Who this is for

You run 200 desks. Quality can't depend on which one answers.

At carrier scale the risk isn't one slow file — it's variance. Medrecords gives every desk the same structured, cited starting point, so cycle time, leakage, and audit results move together.

One review standard across lines, desks, and regions
Leakage flagged with sources before it pays out
PHI audit logging on every file, every access
Book view · Q3 to date one standard
1,208 claims processed — same cited outputall desks
Leakage flagged YTD — $1.2M, sourcedcited
Audit exceptions — zero this quarterPHI logged
New desk onboarded — same output, day oneno ramp
Variance is the risk — consistency is the product

Standardize review. Shrink leakage.

Roll out structured, expert-verified review across every line of business — with the audit trail regulators and reinsurers expect.