Payer-side review logic, applied to litigation

Physician Medical Record & IME Report Review for Litigation.

When the medical record is the case, the review must anticipate how the other side will read it — and where the clinical argument will hold, or fail.

No PHI required to scope · response within one business day
01
Source-referenced

Every conclusion ties to a record citation — not narrative opinion.

02
Payer-grade criteria

Reviewed against InterQual® & MCG® — the standards carriers use.

03
Fixed fee

Flat per-service pricing — never hourly, never a running meter.

04
Safe intake

No PHI by email; BAA and engagement terms before records move.

Our physician has applied InterQual and MCG criteria to 3,000+ payer-side US claim reviews — and serves both plaintiff and defense under conflict-screened, separate engagements. The result is bilateral medical analysis calibrated to how claims are actually reviewed, not generic record summarization.

Medisprudence was built on direct payer-side utilization management experience — applying InterQual and MCG criteria to real claims across a major US commercial payer and understanding exactly how medical reviews are constructed. That operational knowledge applies identically whether helping a plaintiff attorney deconstruct a defense IME or helping a defense team ensure their own IME will survive cross-examination. Medisprudence follows the analysis, not a side — and the fact that both sides are willing to pay for it is the strongest signal of its objectivity.

Read the Founder’s Background →
Services

Physician Medical Record Review Services for Litigation and Claims Defensibility

One reviewer · both sides
conflict-screened, separate matters
New · Serves both sidesMedical Charge & Necessity Review

When the injury isn't the fight but the dollar value of the bills is — necessity, relatedness, coding, and reasonable value in one physician-authored work product, not split between a coder and a doctor.

Plaintiff — Substantiate the specials

Show the treatment and charges are defensible before the defense attacks them.

Necessity, relatedness, coding, and reasonableness, documented.

From $450
Defense / TPA — Billed-charge exposure

Identify unnecessary, unrelated, inflated, miscoded, or duplicative charges.

A documented reasonable-value range, before reserve and mediation.

From $450 · Net 15
Sample Deliverable · Excerpt

See exactly what an attorney receives.

Every billed service tested on four dimensions — necessity, relatedness, coding integrity, and charge reasonableness — with a documented reasonable-value range. Real reviews cover the full charge package. This is the ledger summary.

4-axisReview per line
3–5 daysTurnaround
Browse all sample deliverables →
Guided Triage

Not sure which review fits the matter?

Answer a short, no-PHI checklist to route the matter toward IME analysis, case viability, payer-criteria review, causation support, defense-side exposure, or compliance review.

Start the Signal Check →
No patient identifiers No file upload Static preliminary triage
Field Guide · Free to read

Medical Evidence in Litigation

A physician reviewer's reference on how medical records, IME reports, medical-necessity criteria, and expert opinions behave as evidence.

Read the Field Guide →
IME & defense reports Causation & prior conditions Necessity & payer criteria Daubert & FRE 702 Reserve & bad-faith UR MHPAEA & ERISA criteria
How it works · No-PHI intake

Payer-side utilization review analysis for plaintiff, defense, ERISA, and MHPAEA matters.

Start with a no-PHI inquiry. No records required to get a scope and pricing confirmation.

01 — Send

Send only general facts

Case type, injury, IME status, approximate record volume, deadline, and the decision you need. No PHI by email.

02 — Scope

Scope & safeguards confirmed

Fit, deliverable type, fee, turnaround, and conflict status. BAA and engagement terms handled before records are sent.

03 — Deliver

Physician-authored report delivered

Source-referenced, component-disclosed, structured for the specific case decision.

Request Case Review
Conflict-screened on every matter · Attorney-directed