Field notes on claims integrity
What billing errors look like, what ERISA requires, and how recovery actually works. Everything here is what we do all day.
Figures are illustrative.
Anatomy of an overcharged inpatient claim
A duplicate scan, an upcoded visit, an unbundled panel, and an overstated stay. Four errors on one bill, walked through line by line.
Our blogs
Why self-funded plans fall under federal ERISA law
What fiduciary duty means when the plan pays its own claims.
Upcoding vs. unbundling: how to tell them apart
The two most common errors, and how each shows up on an itemized bill.
Medicare rates, FAIR Health, and what a fair price means
The data that turns "that looks high" into a dispute.
The summary plan description is the audit rulebook
Every dispute is judged against this document. Keep it current.
Auditing the TPA, not just the provider
Adjudication has its own error rate. Someone should check it.
Triage: where the recovery hides
High-dollar claims first. Inpatient and surgical bills carry the highest error rates.
Where AI fits into a claims audit
Every claim still ends with a person's judgment. Here's the part AI actually handles.