For insurers, adjusters & TPAs
The complete treatment picture on a musculoskeletal injury claim, on one timeline, with gaps, prior conditions, and inconsistencies flagged by a clinician who works in orthopedic or spine care, at a published per-page rate. Priced so trying it on one file is an easy call.
The economics, plainly
When a bodily injury or workers' compensation file needs a medical workup, the options have always billed by the hour. Outside nurse review commonly runs $125 to $200 an hour, and most of those hours go to reading and sequencing records, not to judgment. In-house nurse reviewers cost less per hour and there are never enough of them, so files queue behind each other while reserves sit unadjusted.
NaviCase splits the work the way it should have been split all along. Our North America-based orthopedic and spine clinicians do the reading: every accessible, readable page in the confirmed record set, merged into one chronology, with treatment gaps, prior and pre-existing conditions, and inconsistencies within the record identified in context. Your nurse reviewer, medical director, or adjuster then spends their hours on what actually requires them: the evaluation, the reserve, the settlement posture, the IME referral.
The math on one file: a 1,500-page claim file through Summary + Analysis is $600 at our published rate. The same file at a typical outside nurse-review rate of $150 an hour, read at 60 pages an hour, is 25 hours: $3,750. The difference funds a lot of judgment.
Three ways claims teams use us
Claim triage
Every visit, study, and provider on one timeline. The complete treatment picture before reserving, evaluating, or settling, legible in an afternoon.
The nurse-review alternative
The timeline plus treatment gaps, prior conditions, and inconsistencies within the record, each identified in context. The workup that shapes the file before the IME referral.
When you need an opinion
Written opinions from a board-certified orthopaedic surgeon on causation, permanency, disability, and future care, under a separate physician engagement.
Built for a claims office
Registration takes a day, and there is no panel agreement, retainer, or volume commitment to negotiate before the first file. Pricing is published, the total is pages times rate with a $150 case minimum, and your exact number arrives by email, generally the same business day the records do, with a secure link for card or ACH. Payment starts the review and sets a committed completion date. Invoices reference your claim or case number only, never a claimant name, so they route cleanly through claims payments. Records move only through a secure, HIPAA-supported portal, and where NaviCase acts as a business associate under HIPAA, the applicable Business Associate Agreement governs the engagement. When one file becomes a program, volume accounts move to consolidated monthly billing with auto-charge on the confirmed count, and deliverables arrive as PDF and Word on every case.
Asked by claims professionals
That is the design constraint. Findings are reported as the record shows them, nothing shaded to fit a theory, because a summary is only useful if it survives cross-examination. What you tell us at intake shapes the focus of the review, never its findings. The same deliverables our law firm clients build cases on are the ones your file gets.
It is the reading layer, done by a clinician at a per-page rate instead of by the hour. The chronology and flagged findings arrive organized and verified against the source records; your nurse reviewer or medical resources then work from the map instead of the pile. Many files will not need hourly review at all once the record is legible; the ones that do need far fewer hours of it.
A chronological summary as PDF and Word, organized around the case posture you give us at intake, with, at the analysis tier, treatment gaps, prior and pre-existing conditions, and inconsistencies within the record identified in context. Every entry traces to the furnished records. See a sample analysis.
Bodily injury, workers' compensation, and liability claims where the injury is orthopedic or spinal: neck and back, shoulder and knee, fractures, and the soft-tissue claims after collisions and falls. These are most of the injury book, and they are the files where a prior complaint or a treatment gap changes the reserve. Claims that turn on another specialty are outside the focus.
Yes. Volume accounts get consolidated monthly billing, auto-charge on the confirmed count so review starts the day records arrive, and a standing workspace for each office. Start with one file, and move to program terms when the results justify it.
Registration takes a day. Get an instant estimate if you want the number first.
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