The claims audit — start here
Know what breaks. And what it costs.
Every Hypermodel engagement starts the same way: a free, read-only audit of a closed-claims export, against your own standards and the jurisdiction's. Two weeks later you hold a findings report with receipts — yours either way.
01The QA sample
You can't fix what no one reads.
Claims QA still works the way it did on paper: pull a handful of files, hope they're representative.
the QA sample · never read again
100 claim files. Hypermodel reads all of them, daily.
THE DAILY SWEEP — every open file read against your standards; each flag opens to a file-level receipt.
Every flag opens to a file-level receipt.
02The findings
Findings cluster. That's where the money is.
A handful of categories drives most of the cost. The audit ranks them, prices them, and hands you the order to fix them in — the top repeaters become the first automations.
212 identical FROI findings point to one broken workflow. Automate the check; route the exceptions.
03On the record
Every finding arrives with a receipt.
Open any flag and the receipt is already built — the standard cited, the evidence quoted, the recovery drafted. Nothing is written to your system: the audit is read-only.
- Standard
- CA Official Medical Fee Schedule · CPT 97110
- Evidence
- $72.00/unit paid · $38.50 allowable
- Recovery
- Appeal drafted · window closes in 41 days
- Status
- Held for adjuster review
04Getting started
Start with a free audit.
A closed-claims export is enough — name a slice: a line, a region, a team, a quarter.
Audit
Runs read-only on your export.
Findings readout
What breaks, and what it costs.
Implement
Approval-gated automations, on your system.
Live
Impact shows up in the board pack.