Audit Insights Assist
AIA helps reviewers analyze medical records, surface relevant evidence, and generate graphical reports that highlight potential review signals. It is designed to support auditor judgment — not replace it.
From dense medical records to organized, defensible evidence.
What AIA analyzes
- Claim documents and associated medical records
- Coding patterns and documentation consistency
- Alignment with configured policy and guideline checks
- Potential fraud, waste, abuse, and inconsistency indicators
What AIA produces
- Medical-record summaries scoped to the claim
- Extracted evidence linked to its source
- Graphical summaries and visual report components
- Evidence-backed reports ready for auditor validation
Four workspaces. One review flow.
AIA is a web-based workspace with dark and light themes and secure, role-based access. Managers get oversight; auditors get a focused queue.
- Summary — an analytics dashboard for daily oversight: claim activity, weekly and monthly progress, team performance, and completion rates on one page.
- Claims — deep dives into individual claims with preset or custom filters; each claim shows diagnosis codes, valuation, assigned auditor, and progress, and expands for full detail.
- Messaging — direct communication between auditors, providers, and admins, with per-claim threads and group discussions for specific cases.
- Settings — credentials, profiles, and authorized-device management.
The auditor stays in the driver's seat.
AIA prepares the case; the reviewer decides. Every insight links back to the evidence that produced it, so findings can be validated, challenged, or escalated with confidence.
- Case opensThe auditor receives a prioritized claim with prepared records.
- Review signalsAIA presents highlighted indicators with linked source evidence.
- ValidateThe auditor confirms, dismisses, or annotates each signal.
- ReportAIA assembles an evidence-rich report reflecting auditor decisions.
- DecideThe team routes the claim for adjudication, appeal support, or escalation.
Example report components
Reports are built to be read by audit managers, SIU teams, and downstream reviewers — clear findings, linked evidence, and auditor notes in one place.
Claim summary
A concise view of the claim, records reviewed, and checks applied.
Signal breakdown
Each potential indicator with its severity, rationale, and source links.
Visual summaries
Graphical views of patterns, timelines, and record relationships.
Evidence excerpts
Extracted passages tied to the exact location in the source record.
Auditor notes
Reviewer annotations and validation status captured alongside findings.
Exportable findings
Reports formatted for adjudication support, appeals, and escalation.
AIA works best on protected, pre-screened claims.
In the full ClaimClean workflow, Anonymization Service minimizes PHI before analysis and Medical Fraud Filter prioritizes which claims deserve deep review — so AIA's analysis lands where it matters most.
See AIA on a claim workflow like yours.
Request a demo and we'll walk through record review, evidence extraction, and report generation end to end.