Medical bill review that reconciles to the penny.
IntelliReview prices CMS-1500 and UB-04 bills against CA OMFS, Medicare fee schedules, PPO networks, NCCI bundling, and clinical edits. Every allowed amount reconciles line-by-line to the published fee schedule, with the audit trail to prove it.
IntelliReview isn't a black-box pricing engine. Every calculation runs through ~42 sequential SQL procedures that mirror CA Labor Code §9789 line by line: fee schedules, NCCI edits, multi-procedure reduction, billing-provider GPCI, locality-based multipliers, per-page allowances. When the number comes out, you can trace it.
Bills arrive via OCR ingest (Azure Document Intelligence, with an on-prem GPU OCR alternative), manual upload, or EDI 837 feed. PPO network calls run asynchronously through Hangfire so the reviewer keeps moving while the network responds.
Capabilities
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Dual form input
CMS-1500 (professional) and UB-04 (institutional) with structured capture and validation.
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CA OMFS pricing
Full Official Medical Fee Schedule with locality multipliers, GPCI, and per-page allowances.
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PPO network orchestration
Async Hangfire jobs post to configured PPO networks and reconcile responses back to the bill.
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Clinical edits + NCCI
National Correct Coding Initiative bundling rules, mutually-exclusive edits, multi-procedure reduction.
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OPPS + DMEPOS
Ambulatory Payment Classifications for institutional claims and 120% multiplier enforcement for DMEPOS.
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Full audit trail
Every fee-schedule lookup, PPO response, and reviewer override is stamped and traceable.
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IBR-ready
Second Bill Review adjustments flow directly into the MSOFT platform's CA Independent Bill Review workflow — 30-day filing clock from the SBR decision, $195 fee tracking, and refund reconciliation when CA sides with the payer.
Reconciles line-by-line against the published fee schedule.
Not "close enough for a demo." Not "close in aggregate." Every allowed amount ties back to a specific rule - fee schedule, NCCI edit, PPO contract, or reviewer override - with a full audit trail. If a bill prices differently than expected, you can trace exactly why by lunch.
Built for the desk that prices bills all day.
Bill review is a job that punishes vague answers. IntelliReview surfaces the calculation as you review it - schedule, PPO discount, allowed amount, and the reason each edit fired.
Trace every dollar.
Every reduction shows the schedule, edit, or contract that caused it. Overrides require a rationale and get stamped in the audit log.
Focus on the ambiguous ones.
Clean bills price automatically. Bills with unbundling, duplicate lines, or missing modifiers surface with the specific issue flagged.
OMFS conformance in code.
The pricing logic mirrors CA Labor Code §9789 line by line in ~42 SQL procedures. Regulators can trace any number back to a rule.