---
title: "Forensic Medical Claims Review | Avandé"
url: "https://avande.net/what-we-do/forensic-claims-validation"
description: "Physicians and certified coders review the full medical record on high-cost claims to find improper payments automated edits miss. 46% average savings."
last_updated: 2026-10-09
---

POST-SERVICE

# Forensic Claims Validation Physician review of the full medical record

Find the improper payments automated edits miss.

- Health plans & TPAs
- Stop-loss & reinsurance
- Legal & compliance

[Discuss claims validation](https://avande.net/contact) 46% AVG. SAVINGS

## The problem

A 50% discount on an inappropriate claim is still an inappropriate payment.

Most vendors review the claim. Avandé reviews the care behind it.

Overview

## What we do.

Forensic Claims Validation is Avandé’s physician-led review of high-cost claims. Physicians and certified coders read the complete medical record to confirm billed care was necessary, documented and supported.

### Key benefits

1. Pay only for supported care FULL MEDICAL RECORD REVIEW
2. Savings beyond your discounts 46% AVG. SAVINGS
3. Fewer improper payments PHYSICIAN + CERTIFIED CODER FINDINGS

### WHAT WE CATCH

- Unsupported admissions
- DRG miscoding
- Excessive services
- Misrepresented clinical findings
- Inappropriate treatment pathways
- Fraudulent billing

HOW IT WORKS

## Four steps. One standard.

1. Received

    ### Step 01: Claim flagged

2. In review

    ### Step 02: Records requested

3. In review

    ### Step 03: Physician and coder review

4. Determined

    ### Step 04: Findings and recovery

EVERY STEP RUNS ON ANSERA PORTAL

Results

## Measured, not promised.

46% Avg. savings over existing discounts

$51M TPA A · 10-year savings

$14.1M Stop Loss A · 10-year savings

CASE STUDY · CS-01

### Trauma DRG miscoding

A clean claim every scrubber would have paid.

$230K Total savings

Why Avandé

## We review the medicine.

Our largest savings came from claims every other reviewer had already approved.

- SOC 2 Type II
- HIPAA
- BAA
- PHI Protection

typical vendor compared with Avandé
| TYPICAL VENDOR | AVANDÉ |
| --- | --- |
| Checks codes and payment rules | Reads the full medical record |
| Discounts the bill | Eliminates inappropriate payments |
| Accepts claims at face value | Verifies every clinical assertion |

FAQ

## Straight answers.

### What does this find that automated edits miss?

Unsupported admissions, DRG miscoding, excessive services and misrepresented findings, found in the full medical record.

### Who reviews the claims?

Board-certified physicians working with certified coders.

### Which claims do you review?

High-cost and flagged claims, prepayment or post-payment.

### What savings can we expect?

46% average savings, over and above your existing discounts.

Talk to a physician-led team

## Discuss claims validation.

A few sentences are enough.

[Let's Talk](https://avande.net/contact) or call **1-833-328-2633**

## More ways we help

- PRE-SERVICE

    ### Care Assurance

    Explore

    [Care Assurance](https://avande.net/what-we-do/care-assurance)

- ONGOING

    ### Clinical Surveillance

    Explore

    [Clinical Surveillance](https://avande.net/what-we-do/clinical-surveillance)

- TECHNOLOGY

    ### Healthcare IT Services

    Explore

    [Healthcare IT Services](https://avande.net/what-we-do/healthcare-it-services)