Automated Clinical Documentation Audit and Review Platform for Program Integrity

Automated clinical documentation auditing uses AI to review every clinical note, chart, and claim document against specific audit criteria — checking for completeness, medical necessity, coding accuracy, and compliance with payer requirements. Unlike manual spot-checks that cover a small sample, Brellium performs a clinical documentation audit on 100% of charts in real time, surfacing errors before claims are submitted.

Brellium provides continuous network-level monitoring across your entire provider network, using AI to identify documentation anomalies, billing irregularities, and patterns associated with fraud waste and abuse. Rather than relying on periodic post-payment reviews, Brellium surfaces risk signals in real time — enabling program integrity and SIU teams to intervene before improper payments go out.

Configurable audit criteria means you define your own rules. Brellium lets you set plan-specific medical necessity standards, documentation requirements, coding rules, and approval thresholds that match your organization’s policies — rather than forcing you into a generic, one-size-fits-all template. This is critical for payors managing multiple coverage lines with distinct requirements.

Manual chart review typically covers 5–10% of documentation through periodic spot-checks, creating significant blind spots. Brellium audits 100% of charts in real time using AI, catching issues like copy-pasted notes, missing medical necessity justifications, and coding mismatches that manual reviewers often miss. The result is comprehensive coverage without adding reviewer headcount.

Continuous network-level monitoring means Brellium tracks documentation patterns, compliance metrics, and risk indicators across your entire provider network in real time — not through periodic audits. This gives program integrity and operations teams always-on visibility into emerging risks, outlier behavior, and documentation trends across every provider and every coverage line.

Yes. Brellium automates clinical documentation review within prior authorization workflows, routing provider documentation into a unified platform and auditing it against your plan’s medical necessity criteria. This accelerates authorization decisions, reduces manual review bottlenecks, and ensures consistent application of your coverage policies through prior authorization workflow automation.

Brellium validates every claim against payer-specific billing, coding, and documentation requirements before payment. By performing a comprehensive clinical documentation audit on each claim, Brellium catches discrepancies, upcoding, and missing justifications pre-payment — ensuring payment integrity and protecting against improper payment findings during regulatory audits.