MEDICAL RECORD REVIEW FOR INSURANCE CARRIERS

The Fact That Changes the Claim Is Rarely on Page One.

We’ve spent more than 25 years working with medical records. We help your team find the details that matter and trace them back to the source.

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No software to install. No subscriptions. No long-term contracts.

SUPPORTING CLAIM EVALUATION

A Clearer View of the Medical Record Behind the Claim.

Medical records aren’t organized around the questions your team needs to answer. Lexmata helps bring the documented information together for more efficient review.

  • How Did Treatment Unfold?

    Follow diagnoses, procedures, providers, medications, and changes in treatment across the medical record.

  • What Came Before?

    Locate documented medical history that may be relevant to understanding the current injury or condition.

  • What Warrants a Closer Look?

    Review changes in treatment or gaps in the documented medical history. For additional clinical perspective, Nurse Validation is available through our in-house team.

  • How Does It Support the Team?

    Give attorneys and claims professionals organized medical information and supporting records to reference throughout the review process.

MEDICAL RECORD REVIEW SERVICES

See the Medical History. Follow the Source.

Find the medical details that matter, then see exactly where they came from. Our patented Extract OCR process and AI technologies support the review, with findings tied to the source records.

Excerpt from a de-identified Lexmata document summary report: medical records organized chronologically by date, page, and document type, with plain-language summary bullets. Patient and provider identifiers redacted.
Document Summary Report Example

LEXMATA SERVICES

  • Explore

    Organize and navigate complex medical records.

  • FEATURED IN THIS EXAMPLE

    Explain

    Understand documented treatment histories through medical summaries and chronologies.

  • Examine

    Review defined case-specific information when appropriate.

A SIMPLER PROCESS

You Send the Records. We Take It From There.

No new software to learn. Designed to work alongside your existing workflow.

  1. Send the Records

    Upload the records through our website or ask us to arrange a shared folder. Tell us what needs a closer look.

  2. We Review

    We perform the selected review and keep documented findings connected to the original records.

  3. You Receive

    Download hyperlinked PDFs your team can use right away. Qualify.ai findings come in Excel when included in the selected review.

ADDITIONAL CASE SUPPORT

When the Records Call for a Clinical Perspective.

When the medical history calls for a clinical look, Nurse Validation is available as an optional service.

A nurse reviewer examines the available records within the agreed scope, giving your team more context for its own decisions.

Learn About Nurse Validation

FAQ

Common Questions About Medical Record Review for Insurance Carriers.

Can Lexmata help identify pre-existing conditions or prior treatment?

Yes. Depending on the scope of review, Lexmata can help identify documented prior diagnoses, conditions, and treatment histories within the available medical records.

Can Lexmata help identify gaps or inconsistencies in treatment?

Organized records and medical chronologies make intervals between documented encounters, changes in treatment, and differences in documentation easier to recognize. These findings may warrant further review and do not necessarily indicate that treatment did not occur.

Does Lexmata make medical or claims decisions?

No. Lexmata supports medical record review by organizing and presenting documented information. Claims decisions, coverage determinations, legal analysis, and professional judgments remain with the appropriate professionals.

Give Your Team a Clearer View of the Medical Record.

See how Lexmata organizes complex medical records and prepares source-linked findings. We’ll walk you through our services and discuss your team’s review needs.