Everything you need to know.

The free billing health check is a no-cost, no-obligation 20-minute review of your top denial patterns. You share your current top 3 denial reason codes (or your denial summary report), and we'll tell you what's likely causing them and what the fix is. No pitch, no pressure — just a fast, expert read on your biggest billing pain points. It converts to a paid audit only if you see enough value to want the full picture.

Book a free billing health check using the link on our homepage. We'll confirm the appointment via email, you send us your denial summary (or share it on the call), and we walk through your top issues together. From there, if a paid audit makes sense, we'll scope it and send you a proposal within one business day.

From the free health check to a delivered audit report, most Full Practice Audits run 7–10 business days total — a few days to finalize scope and receive your data, plus 5–7 days for analysis and report production. Spot Audits typically run 4–6 business days total. We'll give you a firm timeline when we scope the engagement.

Spot Audits and Full Practice Audits are one-time, project-based engagements — no ongoing commitment. Monthly Monitoring requires a 60-day minimum, then continues month-to-month and can be cancelled with 30 days written notice. White-Label Partner programs are scoped individually.

Yes. HIPAA compliance is foundational to every ClaimIQ engagement. Patient-identifiable information is never part of our workflow. Before we analyze any data, all PHI is removed — names, dates of birth, MRNs, SSNs, and addresses are stripped from every file. We work exclusively with claim-level data: CPT codes, payer names, dates of service, billed/paid amounts, and denial reason codes.

No — we never need direct access to your systems. Your biller exports standard reports from whatever system you use (Epic, Athena, Kareo, AdvancedMD, eClinicalWorks, etc.). These exports are spreadsheet files (CSV or Excel) that your biller can pull in under 15 minutes. We work entirely from those files — no login credentials, no system access required.

We use a secure file transfer process for all data exchange. We'll provide a secure upload link when the engagement is confirmed — do not send billing data via standard email. All files are encrypted in transit and at rest, and deleted from our systems after report delivery.

For a Full Practice Audit, we need four standard exports from your practice management system: Your biller should be able to pull all of these in under 30 minutes from any major practice management system.

Every Full Practice Audit runs through four analytical dimensions: denial pattern analysis (by payer, by code, by reason code — with root cause classification); E&M undercoding scan (your distribution vs. national specialty benchmarks); modifier audit (modifier 25, 59, GT/95, 50, and NCCI bundling conflicts); and payer underpayment review (allowed amounts vs. Medicare benchmark and contracted rates). See our Services page for a full breakdown of each.

We extrapolate from your sample data. For example, if your denial data covers 90 days and we identify a systematic modifier 25 issue affecting 20 claims per month at an average of $150 per claim, we project that as $1,800/month or $21,600/year. Where the sample is small, we flag the confidence level as Medium and note the data limitation. We never overstate findings — if the data doesn't support a confident extrapolation, we say so.

Both. Our AI-assisted workflow processes and pattern-matches your billing data at a speed and scale that manual review alone can't match. But every finding is reviewed and validated by Lex — the founder of ClaimIQ and a 20+ year billing industry veteran — before it goes into your report. You're not getting an automated output. You're getting an expert-reviewed analysis that happens to be powered by AI.

No — we work exclusively with billing and claims data, not clinical records. Our E&M analysis is based on coding distribution patterns compared against specialty benchmarks, not individual chart reviews. If our audit identifies a likely undercoding pattern, we'll flag the documentation elements that should support a higher level — but the clinical documentation review itself is for your coding team or a certified coder to validate.

The report is a professional branded document including: an executive summary with total revenue at risk and top-line findings (suitable for presenting to a physician owner or administrator); a key findings table ranking each issue by annual dollar impact and priority; individual finding narratives with root cause, dollar impact, and corrective action; payer-specific appeal letters ready to send; and a 30-day prioritized action roadmap. It's designed to be board-ready, not just internally useful.

That's exactly what the 1-hour live walkthrough call is for. We review every finding together, and if your team has context that changes the picture — a payer-specific contract term, a known quirk, a billing decision that was intentional — we revise the report before you finalize it. Findings are not set in stone. Our goal is accuracy, not a fixed output count.

Yes — the appeal letters are fully drafted and ready to customize with your practice letterhead, claim details, and payer-specific addressing before sending. They're written to the specific denial reason and payer, citing the appropriate CPT guidelines, CMS guidance, or payer policy that supports the appeal. Your biller reviews and sends them through your normal appeal process.

Scope. A single-provider family medicine practice with one payer mix falls at the lower end. A 5-provider multi-specialty group billing to 8 payers across two locations falls at the higher end. We quote firm prices before the engagement starts — you'll always know exactly what you're paying before we begin. No surprises, no scope creep charges.

In 20+ years of billing work, we have never completed an audit for a practice that had zero revenue leakage. That said, we don't inflate findings or manufacture urgency. If the data shows clean billing in a specific area, we'll tell you — and that's actually valuable information too. If you complete a paid audit and feel the findings didn't justify the engagement fee, reach out to us directly. We'll discuss it.

For Full Practice Audits, we can split payment — 50% at engagement confirmation, 50% at report delivery. Monthly Monitoring is billed monthly, in advance. Contact us to discuss options for your specific situation.

We work across most outpatient specialties including family medicine, internal medicine, OB/GYN, physical therapy, mental health and behavioral health, chiropractic, integrative and functional medicine, dermatology, and multi-specialty groups. We have particular depth in integrative medicine billing given our background with international oncology and wellness practices. If you're unsure whether your specialty is a fit, the free health check is the best way to find out.

Almost certainly yes. Billing companies submit claims — they're not in the business of auditing their own performance. An independent audit is specifically designed to find what your current billing process is missing. Most practices with an established billing company still have systematic undercoding, modifier gaps, or payer-specific denial patterns that have gone unaddressed for months or years. We're not replacing your biller — we're the independent QC layer that tells you how they're actually doing.

That depends on what you're billing. A 2-provider family medicine practice billing $600K/year that's undercoding by one E&M level on 30% of visits is losing $50,000+ annually. A $2,500 audit that surfaces that finding pays for itself 20 times over. Start with the free health check — if your denial patterns or code distribution suggest systematic issues, we'll tell you honestly whether the math makes sense for a full audit.

Yes — we're based in Houston, Texas, but we work with practices nationwide. Everything we do is delivered remotely and digitally, so geography isn't a constraint. Our payer expertise is particularly strong in Texas (BCBSTX, UHC Texas, Medicare Part B for Texas), but we have substantial experience with national payers in other states as well.