A physician-authored review of whether the medical special damages in a claim are clinically necessary, related to the injury, correctly coded, and reasonable in amount — evaluated the way a payer-side reviewer would. Not a billing audit: necessity, relatedness, coding integrity, and charge reasonableness in a single physician work product.
Clinical necessity: Was each service supported by the record under the documentation-threshold logic payer reviewers actually apply?
Relatedness to injury: Is the service attributable to the pleaded mechanism, or to pre-existing or unrelated pathology?
Coding integrity: A physician-led screen for unbundling, upcoding, duplicate, or unsupported line items inflating the total — not a certified coding audit.
Charge reasonableness: How do the charges compare against benchmark data for the same service in the same geography?
Reasonable-value range: What portion of the claimed specials is clinically and economically defensible?
The injury is not seriously disputed, but the dollar value of the bills is — which describes most PI and bad-faith matters.
Plaintiff teams substantiating specials before demand; defense and TPAs scoping exposure before reserve or mediation.
Over-utilization, surprise line items, provider-lien billing, or charges well above the local market.
Degenerative or prior-injury pathology that complicates which charges belong to this claim.
Firms may treat the fee as a case cost, subject to their engagement agreement, applicable law, and case outcome. See the full rate card →
Defense & institutional buyers: Invoiced at scope confirmation. Net 15 terms. Retainer arrangements available for recurring volume.
Each contested service is assessed against the same documentation-threshold logic used in payer utilization review (InterQual / MCG-style criteria), then tested for attribution to the pleaded mechanism versus pre-existing or unrelated pathology. This is the layer a billing analyst cannot reach.
Line items are checked for unbundling, upcoding, duplication, and support in the record. Where engagement scope and available data allow, charges may be benchmarked against available charge and allowed-amount references, CMS fee schedules, hospital price-transparency data, payer-allowed logic, and other jurisdiction-appropriate market references — to express a defensible reasonable-value range.
The MCNR is delivered as physician-authored, attorney-directed consulting work product (non-testifying). For matters requiring a sworn affidavit or trial testimony specifically on charges, we coordinate with a US-credentialed coding/billing expert (CPC/CIC/CPMA) so the testifying layer is held by the right credential.
| Tier | Scope | Starting fee | Turnaround |
|---|---|---|---|
| Settlement Leverage Memo | Single-provider or quick exposure read; non-testifying negotiation support | From $450 | 3–5 business days |
| Standard Review | Multi-provider, single episode of care — the core deliverable | From $1,200 | 5–10 business days |
| Comprehensive Review | Catastrophic, surgical, or high-volume records; full reasonable-value range | From $3,000 | 10–15 business days |
Final fee confirmed at scope before records are transmitted; depends on record volume and number of contested providers. Rebuttal of an opposing party’s bill or damages analysis is available as an add-on.
The methodology and review depths are explained above. This section addresses the practical information needed to scope the work responsibly.
A charge review is materially stronger when the billing ledger and the clinical record cover the same dates and providers. A spreadsheet alone cannot establish necessity or causation.
The final report avoids a single unsupported “reasonable value” conclusion. It presents the clinical and economic reasoning in layers that can be followed and challenged.
A limited charge-pattern screen is possible, but medical necessity and causal attribution cannot be responsibly concluded from billing data alone.
No. Benchmarks answer different questions. The report explains what each source represents and why it may or may not fit the dispute.
It can flag physician-visible coding and utilization concerns. Material coding opinions should be confirmed by a qualified coding or billing expert.
A negotiation memo, a standard clinical-and-charge review, and a comprehensive litigation analysis require different record depth, benchmark work, and documentation.
Plaintiff teams pair it with Case Viability Screening and the Full Intelligence Report. Defense and carriers pair it with Medical Reserve Analysis.
The specimen uses fictional clinical & billing data. No PHI. Live reports are calibrated to the records and jurisdiction of the matter.
No PHI required to start.