Overview
ClaimIQ 2 performs forensic analysis of medical billing claims, identifying compliance issues, coding errors, and reimbursement optimization opportunities.Workflow
Upload claim package
Upload a PDF containing your claim documents:
- CMS-1500 claim forms
- EOB/ERA (Explanation of Benefits)
- Clinical notes
- Lab results
Analysis runs
The pipeline processes your documents:
- Document ingestion — Files are parsed
- Stage 1 (Vision OCR) — AI extracts structured data from the documents
- Stage 2 (Analysis) — AI analyzes coding, compliance, and payer policies
Alex’s screenshot note: Take a screenshot of the ClaimIQ page showing the upload area and the analysis pipeline progress indicator (Stage 1, Stage 2).
Report Sections
Executive Summary
High-level paragraph summarizing key issues found and the overall assessment.Claim Summary
Service lines table showing:- CPT code and modifiers
- Billed amount
- Allowed amount
- Paid amount
- CARC / RARC codes
- Disposition (paid, denied, adjusted)
Clinical Documentation
Extracted clinical details:- Chief complaint
- History of present illness (HPI)
- Review of systems (ROS)
- Assessment and plan
- Lab results
Findings
Individual finding cards, each with:- Finding description
- Compliance risk level (high, medium, low)
- Payer policy support — Relevant policy language
- Recommendations — Suggested actions
Correct Coding
AI-recommended coding:- ICD-10 diagnosis code recommendations
- CPT code approaches
- Excluded CPTs with rationale
Policy References
Links to relevant payer policies with:- Source
- Title
- URL
- Relevance score
Recommendations
Organized into:- Immediate actions — Fix right now
- Prospective corrections — Process improvements
- Compliance monitoring — Ongoing checks
Conclusion
Summary of findings and next steps.History
The left panel shows past analyses:- Patient name
- Payer
- Date of service
- Billed amount
- Number of findings
- Click to reload
Export
Click Export to download the full analysis as JSON.Alex’s screenshot note: Take a screenshot of a completed ClaimIQ report showing the Findings section with 2-3 finding cards of different risk levels.