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Claims auditing for self-funded plans

Find billing errors. Stop overpaying. Recover the difference.

CodaHx audits every claim your plan pays against your plan documents and your state's published rates.

100% OF LINES · NOTHING SAMPLED · EVERY FINDING CITED
CLAIMS QUEUE · MARCH BATCHLIVE
CLAIMBILLEDDUPBUNSPDRATERECOVERED
CLM-2395 office visit$212.00—
CLM-5502 lab panel$184.00—
CLM-8817 MRI brain$2,448.00$2,448.00⚑+$1,836.00
4.0× TX PUBLISHED RATE · BENCHMARK $612.00
CLM-7218 MRI knee$1,048.00—
RETURNED TO PLAN · MARCH$59,566$61,402

TRUSTED AND SUPPORTED BY

Johns Hopkins University
Techstars
CareFirst
[ ENGINE ]

How CodaHx audits every claim

An index of your plan — SPD terms, rate benchmarks, claim history — then parallel checks on every line.

⚑ CLM-8817FULL SWEEP · NOTHING SAMPLED
STEP 01
Indexes your plan
Sweeps everything you already have — SPD clauses, network terms, published rates, claim history.
0450 · 99285 · $2,914.00
0450 · 99285 · $2,914.00
0301 · 80053 · $184.00
0320 · 71046 · $412.00
0270 · SUPPLY · $96.40
DUPES ✓BUNDLE ✓TERMS ✓RATE ⚑
STEP 02
Agents review each claim
Parallel checks — duplicates, unbundling, plan terms, published rates — on 100% of lines.
AAdjuster · Acme plan
We waive ER copays under $50 — don't flag those.
CodaHx
Noted — added to your plan rules ✓
RULE #14 SAVED
STEP 03
Learns your plan over time
Reads your adjusters' decisions to learn what your plan fights and what it waives.
[ PLATFORM ]
CODAHX AUDIT
Catch billing errors
Duplicates & unbundlingPlan-term violations, cited100% of lines, nothing sampled
RATE ATLAS
Benchmark every bill
Your state's published ratesCoverage across all 50 statesFlags anything far above fair
MEMBER ADVOCACY
Protect every employee
Bills explained in plain languageErrors disputed for themLess fear, fewer HR escalations
[ FLOW ]

Every claim, audited before your TPA pays.

01 INTAKE

837/835 batches stream from your TPA.

CLM-00514$8,912
CLM-00515$1,204
CLM-00516$640
02 ANALYSIS ENGINE
4 CHECKS · PARALLELACTIVE
Coding edits NCCI · MUE1,204 cleared
Published-rate check63 flagged
SPD terms & coverageverified
Duplicates & COB12 flagged
03 RESOLVE
CLEARED TO PAY
94.1%
1,204 claims · your TPA proceeds as normal
CAUGHT BEFORE PAYMENT
$184,220
this quarter · corrections sent to TPA
CLAIM → VERDICT · BEFORE THE PAYMENT RUN
[ AGENTS ]

An audit team on every claim

Five specialist agents work each batch in parallel and post findings with citations — your team stays the reviewers.

Medical coding
Bundling, modifiers, duplicates — every line reviewed.
flagged CPT 99285 · 2m ago
Cost benchmarking
Prices every code against your state's published rates.
cited TX benchmark $612 · 4m
Financial aid
Screens bills against hospitals' financial-assistance policies.
#MEM005 · aid eligible · 6m
Renewal optimization
Models stop-loss and renewal, net of documented errors.
stop-loss modeled · $300K
Report generation
Drafts the TPA packet and the plain-language renewal report.
TPA packet drafted · 12 items
[ INSIDE THE AUDIT ]

Your plan's workspace

Recoveries, published-rate deltas, and stop-loss exposure — live, for the employer and the broker.

[ FAQ ]

We detect billing code errors, duplicate charges, unbundling, upcoding, coverage misapplications, and pricing discrepancies in 835/837 claims.

Yes. We use bank-level encryption, are HIPAA compliant, and never share your data with third parties.

We track employee claims against your stop-loss threshold and alert you when approaching the limit, helping maximize insurance coverage and manage financial risk.

We identify employees who may qualify for financial assistance based on household size and income, then help them apply to reduce claim costs.

Yes, we integrate with your TPA to flag coding errors and coverage misapplications before payment, maximizing savings.

See what your plan overpaid last quarter.

A sample audit on one month of your claims — no commitment.

Book a demo