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Pre-Bill Revenue + Coding Integrity with MDaudit’s eValuator™
eValuator™ fills the gap left by manual sampling and basic claim scrubbers. As a module within the MDaudit Platform, it automatically reviews every encounter prior to billing, giving revenue integrity, coding, and CDI teams proactive insights to resolve coding issues and strengthen reimbursement on the first submission.
Direct Benefits to Using eValuator™
100% pre-bill analysis that surfaces high-value opportunities traditional methods often miss
Precise detection of under- and over-coding with estimated financial impact
Reduction in coding-related denials and post-bill rework
Optimized DRG, CC/MCC, and quality adjustments for stronger compliant revenue
Elimination or significant reduction of post-bill audits
Improved first-pass yield rates and overall cash flow across the organization
Cloud based and scalable. Access from anywhere with automatic updates, enterprise-grade security, and zero burden on your IT team.
How eValuator™ Works
eValuator™ sits between coding and billing, applying it’s AI-enhanced rules engine to every coded encounter for final validation. It delivers clear, encounter-specific recommendations so teams can make corrections quickly and confidently before claims are released.
Built as a modern cloud-native solution, eValuator sits between coding and billing, automatically analyzing 100% of encounters in real time without slowing down your processes.
eValuator™’s AI-Powered Rules Engine
At the core of eValuator™ is an evolving rules engine that continuously learns from real encounter and audit data. It follows a structured process to uncover opportunities that static rules or manual reviews typically overlook:
Identify Data – Analyzes key encounter and audit data to spot trends and patterns.
- Identify Data – Continuously analyzes key encounter and audit data to spot trends and patterns.
- Cluster Data – Groups millions of encounters based on clinical and financial similarities.
- Develop or Enhance Rules – A seasoned rules development team with over 70 years of combined HIM and coding expertise evaluates each cluster and builds or refines rules that drive measurable financial impact.
This evolving AI approach has already delivered millions in additional compliant revenue for customers through new and enhanced rules.
Narrative Advice & Encounter Detail
eValuator™ provides precise, encounter-specific recommendations so teams know exactly how to optimize each case. Users see:
- Confidence ratings or “Requires Further Review” alerts for potential DRG or quality changes
- Estimated financial impact to prioritize high-value opportunities
- Clear guidance on coding adjustments, documentation needs, and compliance considerations
Granular detail at the encounter level gives revenue integrity professionals full visibility into how to correct issues in real time before the claim is released to the payer.
Customizable Workflow
Flagged encounters are automatically routed to the appropriate coding or CDI team members. From the role-based dashboard, users can review recommendations, make pre-bill corrections, track metrics, and seamlessly integrate findings into the broader MDaudit audit workflow for ongoing education and process improvement.
Proven Outcomes
Results from customers who have successfully transformed their revenue integrity and coding programs with eValuator™.
Projected Annual Impact $31M Cash Impact
A customer validated eValuator™’s financial impact through 835 remittance analysis after implementation. The solution identified and corrected high-value coding opportunities across their inpatient and outpatient encounters, delivering $31 million in additional captured revenue while reducing coding-related denials.
$11.3M Financial Impact
Another organization leveraged eValuator™’s evolving, AI-driven ruleset to uncover previously missed coding opportunities. The combination of data clustering and expert rule development generated $11.3 million in measurable financial impact through new and enhanced rules alone.
