Consistent, Auditable Bill Validation at Scale
Every scan engine runs on every bill, every time. No reviewer fatigue. No missed bundling violations. Defensible findings with complete audit trail.
Reviewer quality varies from person to person and shift to shift. Fatigue leads to missed violations. In 2024, the DOJ charged 193 defendants with $2.75 billion in healthcare fraud. Consistent, automated review catches patterns that manual review cannot.
16
Scan Engines
2.6M
NCCI Edits
10,500+
MUE Limits
API
Access Available
Process
How NilesAI Works for Claims Teams
Upload or API
Submit claims individually or in batch via API
Extract
Every line item and charge extracted automatically
Scan
All 16 engines run on every claim, every time
Report
Findings with CMS citations and dollar impact
Audit Trail
Complete, defensible record of every analysis
Validation
16 Deterministic Scan Engines
Every scan runs the same way every time — no variation, no fatigue, no missed rules.
CPT Validity
Code Validation
Code Currency
Code Validation
Modifier Validation
Code Validation
NCCI Bundling
Bundling & Compliance
Global Period
Bundling & Compliance
Fee Schedule Variance
Fee & Charge
Charge Outlier
Fee & Charge
Charge Mismatch
Fee & Charge
Duplicate Detection
Pattern Detection
Upcoding Pattern
Pattern Detection
Frequency Abuse
Pattern Detection
Modifier 25 Abuse
Pattern Detection
Bilateral Procedure
Specialty
Anesthesia Time
Specialty
Place of Service
Context-Aware
Units Validation
Context-Aware
Advantages
Built for Claims Operations
Consistent Quality
Same engines, same rules, every claim. No reviewer fatigue or variation.
Scale with API
Batch processing and REST API for high-volume teams. Process thousands of claims.
Fraud Detection
Pattern detection engines catch upcoding, unbundling, duplicate charges, and frequency abuse.
ROI
Calculate Your Savings
ROI Calculator for Claims Teams
Your team could save
$ /month
Hours saved
hrs/mo
Cost with NilesAI
$/mo
Security
Enterprise-Grade Security
HIPAA Compliant
Full HIPAA compliance with BAA
Complete Audit Trail
Every scan logged and traceable
Data Encryption
AES-256 at rest, TLS 1.3 in transit
No PHI in AI
PHI never sent to AI models
Pricing
Simple, transparent pricing
Start free. Pay only when we find billing errors.
Try It Free
No credit card required-
3 free scans per month -
Full compliance analysis across all scan engines -
Summary report with overbilling total included -
$29 detailed report when overbilling meets threshold
Starter
-
15 cases/month (all reports included) -
Additional cases: $25/case -
PDF export and dispute letters -
Priority email support
Professional
-
50 cases/month -
Additional cases: $20/case -
All features including cross-document analysis -
Priority support
Enterprise
-
150+ cases/month -
Volume pricing on additional cases -
Custom integrations -
Dedicated account manager
Need more cases? Additional cases are $25/case on Starter, $20/case on Professional, and volume-discounted on Enterprise. Every extra case includes the full compliance analysis, citations, and dispute letter.
Frequently Asked Questions
You can unlock any additional case for $29 when findings meet the minimum threshold (at least 2 flags or $50+ in potential overbilling). Or upgrade to a Starter or Professional plan for monthly case allotments with lower per-case costs.
Yes. Every scan, free or paid, runs the full compliance analysis including NCCI edits, MUE limits, fee schedule comparisons, and more. Free scans include a summary report. The $29 detailed report adds full citations, dispute letter generation, and line-by-line breakdowns.
Upload your medical bill, EOB, or itemized statement. NilesAI extracts every line item and runs it through a full compliance analysis, including NCCI edits, Medicare fee schedules, and MUE limits. You get a detailed report showing exactly what was flagged and why.
NilesAI can analyze hospital bills, outpatient facility charges, physician invoices, emergency room bills, EOBs (Explanation of Benefits), and itemized statements. Upload them as PDFs or images.
Yes. Your documents are encrypted in transit and at rest. We do not sell or share your data. Bills are processed securely and you can delete your data at any time from your account settings.
Medical billing advocates typically charge hundreds of dollars and take days to review a single bill. NilesAI analyzes your bill in minutes for a fraction of the cost, checking against the same compliance databases that professionals use.
Potential overbilling means NilesAI found charges that may exceed standard rates, violate coding rules, or fail compliance checks. These are flags for you to review and dispute with your provider, not a guarantee of error.
Not at all. NilesAI translates every code and finding into plain language. The report explains what each charge is, why it was flagged, and what you can do about it.
Yes. If NilesAI finds overbilling on a paid bill, you can use the dispute letter to request a refund or credit from your provider. Many providers will adjust charges even after payment.
You pay nothing. The $29 detailed report is only offered when findings exceed the minimum threshold. If your bill is clean, you will see a summary confirming no issues were found, at no charge.
Built on authoritative data
See NilesAI in action
Schedule a demo to see how NilesAI can bring consistency and scale to your claims review process.