MSOFT IntelliReview.
Medical bill review, built into your claims platform.
IntelliReview prices every incoming medical bill in seconds — applying state fee schedules, PPO contracts, UCR benchmarks, and clinical edits — and writes the result directly back to the claim. No exports. No middleware. No surprises.
From 837 to approved payment.
Every step is automated, explainable, and traceable. Your reviewers intervene only on exceptions — the routine bills handle themselves.
Bill arrives
EDI 837 from clearing-house, paper via mailroom OCR, or API submission. Attached to the claim automatically.
Pricing engine runs
Fee schedules (CA OMFS and others), PPO contracts, UCR benchmarks, and clinical edits applied in sequence.
Exceptions surfaced
Duplicates, unbundling, mutually-exclusive codes, and out-of-network charges flagged for human review.
Result written back
Allowed amount, savings, and reason codes posted to the claim. Payment workflow starts. EOR generated.
Everything you'd expect — in one engine.
IntelliReview covers the rules that matter — and is built to absorb new ones as they ship from CMS, state boards, and your own custom logic.
Fee Schedules
California OMFS, federal Medicare/Medicaid schedules, and additional states. Quarterly updates managed for you.
PPO Contracts
Apply network-specific contract rates. Track in-network vs out-of-network, and surface savings by network.
UCR Benchmarks
Usual, Customary, and Reasonable benchmarking by geography and procedure for charges outside the schedule.
Clinical Edits
NCCI bundling, mutually-exclusive code detection, unit limits, age/gender edits, and modifier validation.
Duplicate Detection
Cross-bill, cross-provider, and cross-claim duplicate detection — including near-duplicates with date variance.
Explanation of Review
Auto-generated EOR with line-by-line reductions, reason codes, and references the provider can act on.
EDI 837 Intake
Clearing-house integration with direct 837 ingestion. No re-keying, no batch uploads, no lost bills.
Custom Rules
Layer your own client-specific rules on top of the engine. Tested in a sandbox before production rollout.
Payment Hand-off
Approved amounts flow straight into the MSOFT payment module. Print, ACH, virtual card, or export — your call.
Bill review that already knows the claim.
Most bill-review vendors are external services. You ship them the bill, wait, and wire the result back into your claims system. By that point, the adjuster has lost context, the claimant has waited, and your audit trail has a seam in it.
IntelliReview lives inside MSOFT. It already knows the claimant, the jurisdiction, the policy, the body part, the prior bills, and the reserve. That context makes the engine faster, the exceptions smarter, and the audit trail seamless.
- No data export, no integration brittleness, no vendor seams
- Pricing logic uses claim context (jurisdiction, body part, history)
- Single audit trail: intake → review → approval → payment
- Pay one platform fee — not platform plus per-bill review fees
See IntelliReview run on your bills.
Send us a sample batch (de-identified) and we'll show you what IntelliReview would have done with it. Free, no commitment.