Frequently Asked Questions

ClaimGrade is a HIPAA-compliant platform that reviews prosthetic and orthotic chart notes against HCPCS L-code policy requirements. Upload a physician or O&P chart note, select the codes you intend to bill, and ClaimGrade grades the documentation criterion by criterion — showing what supports medical necessity, what is missing, and how to fix it before the claim is submitted.

Yes. ClaimGrade is built for Protected Health Information: encryption in transit and at rest, audit logging, and a Business Associate Agreement (BAA) included with every plan.

No — general-purpose AI chatbots are not HIPAA-compliant environments for patient documentation, they do not carry a BAA, and their answers are not maintained against current LCD and policy-article criteria. Pasting chart notes into a consumer chatbot can constitute a PHI disclosure. ClaimGrade provides the same convenience inside a HIPAA-compliant boundary, with grading logic that is updated the same day Medicare policy changes.

AI scribes help write notes. ClaimGrade independently grades notes — including the referring physician’s documentation, which most O&P denials actually hinge on. Many practices use both: a scribe to draft, ClaimGrade to verify the result supports every code before billing.

ClaimGrade shows exactly which policy criteria failed and why. For physician documentation gaps, it drafts an addendum request letter targeted at those specific criteria and can fax it directly to the referring physician’s office.

Policy updates — LCD revisions and policy-article changes from the DME MACs — are ingested the same day they publish, and grading criteria are refreshed to match. When rules change, you are grading against the new rules immediately, not after a quarterly refresh.

ClaimGrade covers HCPCS L-codes for prosthetics and orthotics, from base codes through additions, each validated against its own coverage criteria. Codes are immediately updated based on policy article changes.

Yes — ClaimGrade grades documentation from any system. Export or print a chart note to PDF from OPIE, OP Compass, Nymbl, or any EMR (or scan a paper note), upload it, and grade it. No integration project required.

Yes — and that is the point. Supplier documentation can only corroborate; Medicare requires the referring physician’s record to establish medical necessity on its own. ClaimGrade grades physician notes independently and generates the addendum request when they fall short.

Credit-based plans start at $99/month (Basic), with Pro at $399/month and custom Elite volume. Every plan includes every feature and unlimited users — plans differ only in how many cases you grade per month. Unused credits roll over.

Under a minute for a typical chart note — versus the 20–60 minutes a manual policy review takes an experienced billing specialist.

ClaimGrade is built with practicing O&P clinical and reimbursement expertise, including advisors who have co-authored industry coding and reimbursement education for over two decades. It is used daily by O&P practices across the country.