Paid more than the record supports
Codes the record doesn't support
A complication with no treatment behind it, or a severity the notes don't show. These move a claim into a higher-paying group.
For insurers and health funds
Settle claims on
the evidence
MEDIKODI Lens checks the coding behind every hospital claim you pay, and shows the evidence for every finding, in both directions.
When a claim is paid by DRG, the codes decide the benefit. But checking them means requesting records, waiting, and reviewing a sample by hand.
Every claim, not a sample
Request records only where they matter
Upload a month or a year of claims. Lens checks each one and tells you which are worth a record request, and why.
- What a manual audit has time to reach
- A sample
- What a manual audit has time to reach
- In the period, checked by Lens against the same rules
- Every claim
- In the period, checked by Lens against the same rules
Findings in both directions
A check hospitals can't call one-sided
Paid less than the record supports
Care documented but not coded
Conditions and procedures the record supports that never made it onto the claim. Reported separately, so neither side hides the other.
Reporting both is what makes the findings credible, and what keeps the relationship with the hospital intact.
Ready for the right of response
A finding the hospital can check for itself
Every finding is written up so it can go to the hospital as it is. No opinion against opinion.
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The code
What was claimed, and the group it put the episode in.
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The record
The line in the notes that supports it, or the absence of one.
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The rule
The coding standard or convention that applies, by name.
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The impact
Where the episode groups if the finding stands.
Across your network
See drift before it becomes the norm
One claim rarely tells you much. A hospital whose complexity keeps climbing while its peers stay flat does.
Compare hospitals, DRGs and periods against the same indicators, and go into the next contract conversation with the pattern in hand.
One method, both sides of the claim
The hospital sees the same finding you do
Hospitals can run Lens on their own coding with the same rules. So when you disagree, you're discussing the record, not whose method is right.
Now taking pilot partners
Try it on claims you've already paid
The fastest way to judge Lens is against an audit you've already done. You'll see what it agrees with, what it adds, and what it would have saved you requesting.
Join the Lens pilot-
First call
Pick a question you already have
A hospital, a group of DRGs or a period that's been on your mind. The pilot answers something real.
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Before anything moves
Agree the data
Claim data alone, or with the admission records. How it's shared is agreed with your privacy and security teams before anything moves.
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Once Lens has run
Walk through the findings
We go through every finding with your team, and compare it with your past audit results if you'd like.
What health funds ask
Do we need the clinical record, or just the claim data?
Either works. With coded claim data alone, Lens checks the coding against the classification, the coding standards and the grouping. With the admission's documentation, it also checks each code against what the record says.
Does Lens replace our clinical coding audits?
No. It tells your auditors which claims are worth reviewing and why, so records are requested where they matter. A qualified auditor confirms each finding, and your team decides what to raise with the hospital.
Will hospitals accept the findings?
A finding shows the code, the line in the record and the rule, so the hospital can check it directly. Hospitals can run Lens too, with the same rules, so a disagreement is about the record rather than the method.
Is Lens only looking for over-coding?
No. It also reports documented care that wasn't coded. The two are reported separately, which keeps reviews fair and conversations with hospitals easier.
How is member data handled?
Lens assesses only the episode being claimed, not a member's wider history. Sensitive details are de-identified before assessment, and hosting is agreed with your IT and security teams. See security & trust.
Check a sample of your claims
Lens is in a pilot with a small group of insurers and providers. Send a sample of claims and see what it finds.