About Inpatient Itemized Bill Review (BRAID™)

Inpatient medical bills are among the most complex and highest-risk claims in group health. Thousands of line items, bundled services, and inconsistent billing practices make overpayment difficult to detect through standard claims systems alone.

Even in-network inpatient claims can contain excessive, unsupported, or improperly billed charges that persist after PPO discounts are applied. Once paid, these inaccuracies are difficult to unwind and often resurface only when challenged later.

BRAID™ exists to bring accuracy to inpatient reimbursement. By combining advanced automation with physician-led review, BRAID analyzes inpatient medical bills at the line level to ensure reimbursement recommendations reflect what was actually provided and what is supportable, not what was billed.

Core Components

• Line-Level Inpatient Bill Review: Each inpatient medical bill is reviewed charge by charge to identify excessive, unsupported, or inconsistent billing.
• Physician-Led Clinical Review: Experienced physicians evaluate utilization, medical necessity, and appropriateness to validate billed services and recommended reimbursement.

Why Line-Level Accuracy Matters For Inpatient Claims

Inpatient reimbursement decisions are rarely challenged as a single number. They are challenged one line item at a time.

BRAID does not rely on broad assumptions or percentage-based reductions. Recommendations are grounded in accurate, line-level bill review and supported by physician oversight, allowing them to remain consistent when examined by providers, consultants, or plan sponsors.

When applied to eligible inpatient medical bills and claims, this approach results in additional savings of up to 40% beyond PPO reductions. More importantly, reimbursement recommendations hold because they are rooted in bill-level facts, not averages.

• Automation-Driven Rules Engine: BRAID leverages artificial intelligence to flag billing anomalies, apply consistent logic, and improve accuracy with each bill reviewed.
• Provider Profiling And Pattern Recognition: Identified billing patterns are tracked to support faster, more consistent review of future inpatient claims.

Let’s Take A Look

Start with a single inpatient medical bill or claim.

Whether paid or unpaid, BRAID can help clarify what should have been reimbursed and why accuracy at the line level makes the difference.