Internal Audit · Hospitals · Payers & MCOs · Federal, State & CMS programs
Audit yourself before they do.
JIL Internal Audit runs the same deterministic compliance rule catalog an external auditor would use, except you run it first, against your own billing, providers, nurses, diagnostic tests, and utilization. Every exception comes back with the required remediation, and every payment that was correct is attested in an Audit-Ready Evidence Bundle (AREB).
A RAC, UPIC, or payer audit arrives with a sample and a finding. Continuous internal audit means you already found the errors, already fixed them, and can hand an auditor a signed, court-anchored record that the rest was right. The audit doubles as your remediation plan.
See it on a live demoWhat it audits
Your own records, against the full rule catalog.
The same deterministic checks used to defend a finding are turned inward. JIL runs the catalog against your claims (Mode A), and with source-record access such as a FACETS extract, against the documentation-level rules as well (Mode B). Each check is explicit, reproducible, and date-aware, so a status that took effect after the date of service is never applied retroactively.
Provider integrity
Exclusion screening (LEIE, SAM, state lists) with an effective-date gate, license status and expiration, and enrollment and revalidation state (PECOS). A payment is only flagged when the status was in force on the date of service.
Nurse and clinician credentials
License status and discipline, scope of practice for the service billed, and supervision and incident-to requirements, so an unsupervised or out-of-scope service is caught before an external reviewer raises it.
Coding and claim integrity
NCCI procedure-to-procedure unbundling, Medically Unlikely Edit (MUE) unit ceilings, upcoding against documented intensity, duplicate and split claims, modifier misuse (including 25 and 59), and place-of-service consistency.
Diagnostic test review
Medical necessity against the supporting diagnosis, frequency limits and look-back windows, and ordering-provider validity, so panels, imaging, and lab tests that fail coverage criteria surface in your own audit first.
Utilization thresholds
Per-provider, per-beneficiary, and per-service volume and outlier thresholds, flagging patterns that sit above the peer distribution before a UPIC or payer data-mining unit flags them for you.
Claims and source records
Mode A runs against claim and remittance data alone. Mode B unlocks the documentation-level rules when source-record access is available (for example a FACETS extract), turning rules not asserted into rules tested.
Errors plus remediation
Every exception ships with its corrective action.
A finding without a fix is just more risk. JIL pairs every exception with the specific remediation the rule requires, so the audit output is also a remediation work plan your compliance and revenue-integrity teams can execute against.
Coding corrections
An upcoded or unbundled claim returns the supported code level and the refund or adjustment amount, so the correction and the dollars are stated together, not left as an open question.
Enrollment corrections
A lapsed or revalidation-due enrollment returns the action to reactivate or revalidate the NPI, with the gap window stated, so the provider record is brought current before the next claim.
Documentation corrections
A missing order, signature, or supervision record returns the specific attestation or document to obtain, so the documentation gap is closed rather than carried forward.
Remediation as a plan
Exceptions roll up into a prioritized remediation plan grouped by rule, provider, and dollar exposure, so the audit becomes the corrective-action roadmap, not just a list of problems.
The AREB
An Audit-Ready Evidence Bundle for the payments that were correct.
CREB™ and RREB™ document what went wrong. The AREB documents what went right. It is a concise, auditor-facing report that attests the population, the methodology, and the controls, so when a RAC, UPIC, or payer reviewer arrives, you hand them a signed record rather than starting from a blank sample.
Attestation statement
A plain statement of the population audited, the period covered, and the result: the payments tested against the rule catalog that passed, with their cryptographic seal.
Methodology
The rules run, the data in scope, the Mode A or Mode B basis, and the date-aware logic applied, so the audit is reproducible and the basis of opinion is explicit.
Control matrix
Each control mapped to the rule that tests it and the result, so a reviewer can trace a compliance requirement straight to the evidence that it was met.
Exceptions with remediation
Any exceptions found, each with its corrective action and status, so the report shows both the clean population and the remediation already underway on the rest.
Rules not asserted
An honest boundary: the rules that could not be tested without source-record access, named explicitly, so the AREB never overstates what was checked.
PDF, Excel, and CourtChain
Download the report as a PDF and the underlying ledger as Excel. The bundle is cryptographically signed and court-anchored on CourtChain, self-authenticating under FRE 902(14).
Who it is for
For anyone who has to pass the external audit.
If your payments are subject to a RAC, UPIC, payer, or program-integrity review, you can run that review on yourself first, fix what it finds, and keep the evidence that the rest was correct.
Hospitals and health systems
Revenue integrity, compliance, and internal audit teams who want to find coding, enrollment, and documentation errors and remediate them before a RAC or UPIC sample lands.
Payers and managed care
Plans and managed care organizations that need to demonstrate program integrity to regulators and contracting agencies, and to attest the claims that paid correctly.
Federal, State, and CMS programs
Program-integrity and oversight units that want a continuous, reproducible internal audit and a court-anchored record of compliant disbursements.
Engagement model
A flat engagement fee, plus AREB report blocks.
Internal Audit is delivered as a flat-fee engagement that stands up the rule catalog against your data and produces the remediation work plan, with AREB report blocks for the audit-ready evidence you issue to reviewers. Remediation findings carry no contingency, so the audit is purely on your side. Pricing scales with population and the Mode A or Mode B scope, and is shared under engagement rather than published here.
Run the audit on yourself first.
Brief your compliance, revenue-integrity, or internal-audit team. We will walk the rule catalog across providers, nurses, billing, tests, and utilization, the remediation work plan, and the Audit-Ready Evidence Bundle (AREB), cryptographically signed and court-anchored on CourtChain.
See it on a live demo Request an internal audit POC