Claims Audit

Verify every payment.
Recover what's owed.

Traditional audits sample a fraction of claims and miss most errors. We verify every historical payment against your contracts—identifying overpayments, underpayments, and missed recoveries with full traceability.

Claims Audit
Your Claims
Verifying...100%
Audit complete
48 claims verified
8
Issues found
$2.3M
Recoverable
Every claim verifiedFull audit trail
Coverage
100%
vs 5% sampling

Most errors never get checked.

Traditional sampling
Claims checked
500 of 10,000
Errors found
1
Errors missed
3
Recovered$420K
Full verification
Claims checked
10,000 of 10,000
Errors found
4
Errors missed
0
Recovered$2.3M
$1.9M left on the table with sampling
Payment errors aren't random — they're systematic
75%
Missed recoveries

What if you could verify every claim, not just a sample?

See how it works

From contracts to verified claims.

We translate your contracts into executable logic, then run every historical claim through it. No sampling. No guesswork.

1
Ingest contracts
PDFs, fee schedules, amendments
// Section 4.2 - Pricing Terms
NDC:00002-3227-30
WAC:$8,247.00
Rebate:23.5% of WAC
Cap:$1,938.05
2
Translate to logic
Every clause becomes executable
// Generated verification rule
function verifyRebate(claim) {
const expected =
claim.wac * 0.235;
return claim.rebate <= 1938.05;
}
3
Verify every claim
100% coverage, not 5% sampling
CLM-0847291
$1,938.05
CLM-0847292
$1,938.05
CLM-0847293
$2,412.18
CLM-0847294
$1,938.05
12,847 claims processed23 discrepancies found
Auditable findings
Every dollar traceable to source
Rebate cap exceeded
$1.4M
§
Contract clause
Section 4.2.1 — Cap at $1,938.05
#
Claims affected
847 claims over 18 months
Δ
Variance
$2,412.18 paid vs $1,938.05 owed
Full claim-level detailExport ready →
2-4 weeks
Typical timeline
No replacement
Works alongside your stack
Full traceability
Every finding documented

Where the money is.

Every audit surfaces a mix of issues. Here's a typical breakdown from a single contract review.

Overpayments
$1.2M
Missed rebates
$420K
Underpayments
$380K
Pricing errors
$210K
Contract leakage
$90K
Total recovery opportunity

From one contract audit

$2.3M

Every finding traces back to the contract.

No black boxes. Each discrepancy shows exactly which clause was violated, how the calculation was done, and why the claim failed.

Claim under review
Claim ID
CLM-0847293
NDC
00002-3227-30
Modifier
-59
Base price
$2,450.00
Paid amount
$2,450.00
Applicable contract clause
§4.2.1Modifier Pricing

"Claims with modifier -59 shall be reimbursed at 50% of base price, not to exceed the applicable fee schedule maximum."

Verification applied
Expected payment
$2,450.00×50%=$1,225.00
Actual payment
$2,450.00
Overpayment
$1,225.00
Verification failed
Modifier -59 paid at 100% instead of 50%
Recoverable
$1,225.00
Contract: §4.2.1Rule: MOD_59_PRICINGVerified: Dec 15, 2024
View full audit log →

This pattern repeated across 847 claims

Total recovery: $1,247,832

The right moment for an audit.

Most teams start with a historical review at a natural inflection point.

Renewal approaching
47 days
Documented errors
$2.1M
Negotiation leverage
Strong

Contract renewal

Enter negotiations with documented proof of payment errors and concrete recovery opportunities.

Dispute ready
CLM-8472§4.2.1$474.13
CLM-8473§4.2.1$474.13
CLM-8474§4.2.1$474.13
847 claims documented$1.2M total

Dispute preparation

Build an airtight case with claim-level evidence, contract references, and calculated variances.

PBM Compliance23 issues
Modifier pricing
12 violations
Rebate calculations
8 violations
Fee schedule
3 violations
Dispense fees
Compliant

Vendor validation

Verify your PBM or administrator is actually following your contract terms—not their interpretation.

Audit
Recover
Monitor

Two files. Two weeks. Real answers.

No integrations. No system access. Just evidence of what you're owed.

You provide
Contract PDF
Pricing terms, rebate schedules
Claims data
CSV or standard export
Time to share< 1 day
2-4 weeks
You get
Identified recovery$2.3M
847
Claims flagged
12
Error patterns
Full audit trail
Contract references
Export-ready

Start with one contract. See real findings in weeks, not months.