Audit every Inpatient chart before billing
AI that audits in under 5 minutes.
sits directly between your EMR and your billing system, autonomously validating every inpatient chart for clinical accuracy, DRG integrity, and documentation completeness – so denials & downgrades are prevented, and PSI/HAC gaps are caught and routed for correction before they reach the payer. 
PROBLEM
Four Risks.
Every Billing Cycle.
- How to "prioritize" chart reviews for pre-bill audits?
- How to capture PSI, HACs without spending a lot of resources?
- How to leverage technology for DRG optimization?
- How to catch errors and prevent denials/downgrades?
CORE CAPABILITIES - PRE-BILL, UNDER 5 MINUTES
Autonomous Checks
Every Chart.
Before Every Claim.
Pre-Bill Audit AI completes clinical validation, DRG verification, CC/MCC detection, and documentation gap detection on every inpatient encounter – before billing is triggered, not after a denial arrives.
Clinical Validation Checks
AI performs the clinical validation checks in a fraction of time, preventing denials proactively
Proactive Clinical Validation built-in
PSI, HAC & CC/MCC Detection
Flags uncaptured indicators for documentation correction – protecting CMI and loss of reimbursement.
Active on every inpatient chart
Denial Mitigation
Validates every MS-DRG assignment against the full clinical record – defensible against payer audits.
Active before every claim is released
100% Audit-Ready Claims.
No Additional Headcount Required.
100%
Charts reviewed
before billing
<5 min
Avg. time
per inpatient chart
5x
Stronger audit
defense per claim
85%
Reduction in
manual review effort
*Based on client implementations and operational modeling or Results vary by organization or derived from health system pilot outcomes.
Pre-Bill Coverage
for Every Inpatient Claim
Manual teams review 10–20% of charts – leaving 80% unchecked. Pre‑Bill Audit autonomously reviews every chart before billing, catching gaps before they reach the payer.
100% Pre-Bill
Coverage
Queries Before
Discharge
Full DRG
Validation
Complete
Audit Trail
KEY FEATURES
AI-native Workflow Designed by RCM Experts
Smart Workflow, Easy to Follow, 100% Compliant
Pre-Bill Audit does more than flag errors. It gives CDI specialists, coders, and RCM leadership autonomous, evidence – backed intelligence on every inpatient chart – before risk reaches the payer.
Autonomous
Query Generation
Compliant physician queries, generated without
manual intervention
When clinical evidence points to an uncoded diagnosis or conflicting documentation, Pre-Bill Audit generates a high‑accuracy, compliant query to the physician automatically, while the encounter is still active, when response rates are highest.
DRG Clinical
Validation Logic
AI reviews every inpatient encounter 100%
before claims get billed
A multi-agent reasoning AI engine cross-checks for accurate DRG assignment against the entire clinical record, ensuring every diagnoses for clinical validation, and DRG is clinically defensible and aligned with payer – specific rules before submission.
PSI & HAC
Opportunity Detection
Quality gaps flagged before they become
reimbursement penalties
Pre-Bill Audit identifies clinical indicators suggesting a Patient Safety Indicator or Hospital-Acquired Condition and flags them for documentation correction – protecting CMI, quality scores, and preventing reimbursement penalties.
Audit Trail &
Compliance Reporting
A complete, version-controlled record behind
every claim
Pre-Bill Audit maintains a full version history of every pre‑bill adjustment and query for total compliance. Every change is recorded and available for review – giving your RCM and compliance teams a defensible record that holds up under any payer review.
Provider Scorecards &
Audit-Readiness Reporting
Recurring documentation patterns surfaced before they
drive recurring denials
Real-time analytics power provider‑level scorecards and audit‑readiness reports, giving CDI and RCM leadership the data to identify where documentation issues originate and address them at the source.
Readmissions
Reporting
LEADERSHIP DASHBOARD
For Leaders Who
Need Answers,
Not More Reports
The CAiRE+ leadership dashboard surfaces the metrics that matter most at a glance, in real time — so leaders can answer ‘what’s in it for me’ immediately.
- Real-time insights
- Actionable intelligence
- Better decisions, better outcomes
Download the 
Product Brochure
Question & Answers
Frequently Asked Questions
Pre-Bill Audit connects directly to your EMR through HL7/FHIR and healthcare APIs, and integrates with your billing system to sit between the two as an autonomous safety net — reviewing every chart and releasing clean, audit-ready claims.
Yes. Pre-Bill Audit is built on Google Cloud Platform with HIPAA-ready enterprise security, including identity and access management (IAM), network isolation (VPC-SC), data loss prevention (DLP), and encryption key management (KMS) - protecting patient data at every layer.
Pre-Bill Audit reviews 100% of inpatient encounters before billing — not a sample. Every chart goes through clinical validation, DRG verification, CC/MCC detection, and documentation gap detection before a claim is released.
Health systems using Pre-Bill Audit review 100% of charts before billing, flag DRG mismatches and documentation gaps before submission, reduce manual review effort by up to 85%, and achieve 5x stronger audit defense per claim — all without adding headcount.
Pre-Bill Audit processes 100% of inpatient discharges autonomously, allowing CDI and RCM staff to focus exclusively on complex cases that require human-in-the-loop escalation — rather than spending capacity on routine first-pass chart review that the platform handles automatically.
See in Action
Protect your revenue integrity, eliminate preventable denials, and give your RCM team complete pre-bill coverage on every inpatient encounter. Schedule a live demonstration built around your health system’s specific documentation and audit challenges.
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