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How We Find Your Missing Revenue

A controlled audit process for Ontario surgical IHFs. AI narrows the search, certified billing expertise confirms the findings, and your team decides what to resubmit.

01

Upload

Your team exports recent OHIP submissions, remittance advice, rejection reports, and selected operative notes. We provide a simple checklist before anything is transferred.

Most clinics start with a representative 60 to 120 day sample. That is enough to reveal underbilling patterns without overloading your administrative team.

Files are uploaded through a PHIPA-compliant portal. No shared inboxes, no consumer file links, and no untracked copies.

Data handling: Patient identifiers are separated from the audit data before AI review. Timeline: 15 minutes to upload once exports are prepared.
02

Analyze

The audit engine compares every claim against the April 2026 Ontario Schedule of Benefits, specialty-specific billing rules, prior rejections, and operative documentation.

It looks for missed assistant fees, complexity premiums, secondary procedure codes, time-based codes, and documentation language that may support a higher-value claim.

Nothing is treated as a recommendation yet. At this point the AI produces candidates for expert review.

Data handling: AI sees de-identified claim logic and clinical text only. Timeline: 5 to 10 business days for first-pass analysis.
03

Report

A certified OHIP billing consultant reviews each candidate and removes weak, unsupported, or clinically ambiguous items.

The final report shows the missed code, dollar value, affected case, supporting documentation, and whether the finding is a resubmission, documentation change, or future workflow fix.

Clinic owners get a summary view. Billing staff get the operational detail they need to act.

Data handling: Reports are access-controlled and retained only as long as required for the engagement. Timeline: report delivery usually follows within 2 weeks.
04

Recover

Your team approves which recommendations to implement. Clinic Claims does not submit claims automatically and does not make changes without your sign-off.

We help your billing team prioritize items still inside OHIP's resubmission window and separate one-time recoveries from process changes that prevent future leakage.

Recovered amounts are tracked against the report so the financial outcome is clear.

Data handling: You remain the custodian and decision-maker. Timeline: many clinics see first recovered payments in about 6 weeks.

What the AI Actually Does

The system is not a black box that submits claims. It is a structured audit layer that reads billing data, compares it against Ontario rules, and highlights mismatches for human validation.

De-identification

Patient data never touches AI in identifiable form. Names, health card numbers, and direct identifiers are removed before processing.

Schedule Cross-Reference

Claims are checked against the Ontario Schedule of Benefits, including April 2026 updates relevant to surgical IHFs.

Premium Detection

The engine scans for operative facts that often support complexity premiums, assistant fees, or time-based billing.

Documentation Coaching

When the clinical work was done but the note is too sparse, we flag language gaps that could affect future claims.

The Human Layer

AI flags. Experts confirm. You decide.

Every recommendation is reviewed by a certified billing consultant before it reaches your team. We do not recommend a code change simply because software found a pattern.

You review the report before any resubmission. Your clinic decides what to pursue, what to leave alone, and what to change prospectively.

There are no automated submissions without approval. That matters when recommendations must be clinically sound and legally defensible.

Common Questions

Yes. We use Canadian hosting, access controls, de-identification, and a process designed for Ontario healthcare privacy obligations.
We need the minimum clinical documentation required to validate billing opportunities, usually operative notes tied to sampled claims.
A first audit usually takes 10 to 15 business days after complete files are uploaded.
We only recommend changes supported by documentation and reviewed by billing experts. Your clinic approves every action before resubmission.
For MVP engagements, we work from standard exports. Deeper integrations can be scoped after the first audit.
Accuracy varies by specialty and documentation quality. We report confirmed findings separately from possible workflow improvements.
The first audit has no upfront cost. Our fee is 15% of recovered amounts from validated findings.
Cataract, orthopedic, gynecology, general surgery, and other Ontario IHF surgical specialties.
Yes, when they are still within the applicable OHIP resubmission window and the documentation supports correction.
We are an audit and recovery layer. Your billing team stays in control while we find leakage and validate opportunities.
Next Step

Start with a focused sample audit.

We will tell you what files to export and what your clinic can expect before anything is uploaded.

Book Free Audit →