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

three

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.

Measurable revenue cycle performance through autonomous pre‑bill review, AI‑backed clinical reasoning, and complete audit‑trail coverage on every inpatient encounter.

100%

Charts reviewed
before billing

<5 min

Avg. time
per inpatient chart

5x

Stronger audit
defense per claim

85%

Reduction in
manual review effort

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*Based on client implementations and operational modeling or Results vary by organization or derived from health system pilot outcomes.

WHY PRE-BILL AUDIT

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.
Line

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.

Line

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.
Line

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.
Line

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.
Line

Readmissions
Reporting

Patterns your team can act on Longitudinal reporting across readmission drivers, payor behaviour, PAC performance, and intervention outcomes – giving leadership and care teams the data to close the loop.
Line

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

Request the product brochure to review Pre‑Bill Audit capabilities in detail and circulate it across your revenue cycle, CDI, and compliance teams.

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    Question & Answers​

    Frequently Asked Questions

    Explore this section to learn more about Pre‑Bill Audit AI.
    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.
    Book a Demo
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