Bill Review

When billed charges are driving claim value as much as underlying liability, bill review is essential. Criterion matches your file to a bill review professional whose experience fits the case — not just the category.

Request bill review All services
Matched to case type and file
Line-item billing analysis
Written report delivered
Pairs with IME and peer review
The Service

When the bill is as disputed as the injury.

In personal injury, workers' compensation, and medical malpractice litigation, the damages number is often driven less by what happened to the plaintiff and more by what was billed for treating it. Bill review addresses that directly.

A bill review professional examines the medical bills submitted as damages — line by line — and evaluates whether the charges are reasonable, medically necessary, and consistent with the services actually provided. They identify billing issues that inflate the claimed damages number and produce a written report that quantifies the appropriate value of the bills at issue.

Criterion reviews your case type and all file specifics before matching you with a bill review professional. The match is not made by specialty category alone — we look at the specific procedures billed, the care setting, the applicable fee schedule or reasonable value standard in the relevant jurisdiction, and the reviewer's track record with comparable files. That specificity is what separates a useful bill review from a generic one.

"A bill review is most valuable when the gap between what was billed and what was reasonable is significant enough to matter at settlement or trial — and most cases involving hospital charges, surgical procedures, or extended treatment have exactly that gap."

Bill review is frequently used alongside peer review or IME, since both the medical necessity of the treatment and the reasonableness of what was charged may be at issue simultaneously. Criterion can coordinate all three services concurrently when the case calls for it.

What Bill Review Identifies

Common billing issues that affect damages

These are the categories of billing problems that a qualified bill review professional evaluates and documents in the written report.

Charges above reasonable value
Billed amounts that significantly exceed the prevailing reasonable value for the same service in the same geographic market, regardless of whether insurance paid a negotiated rate.
Upcoding
Procedure or diagnosis codes billed at a higher complexity or severity level than the documentation in the medical record supports — artificially inflating the per-service charge.
Unbundling
Billing separately for procedure components that should be billed together under a single code — resulting in higher total charges than proper coding would produce.
Duplicate billing
The same service, procedure, or supply billed more than once across different providers, facilities, or billing dates — sometimes spanning multiple records sets that are not reviewed together.
Medically unnecessary services
Procedures, diagnostics, or treatment modalities billed that are not supported as medically necessary by the clinical documentation — often identified through concurrent peer review.
Hospital lien issues
In cases involving hospital liens — particularly where the lien amount significantly exceeds what insurance would have paid — bill review quantifies the appropriate lien value and documents the basis for reduction.
How It Works

From case intake to written report

Criterion manages the matching and coordination. You provide the case details and billing records — we handle the rest.

Submit your case and billing records
Provide a summary of the case, the type of injury or condition at issue, the jurisdiction, and the billing records to be reviewed. Note whether you also need peer review or IME coordination — we can run those concurrently.
File and case type review
Criterion reviews the full case profile — injury type, care setting, procedures billed, applicable fee schedule or reasonable value standard, and the jurisdiction — before selecting a bill review professional. The match is made on fit, not availability.
Bill review professional matched and engaged
We identify a bill review professional with directly relevant experience — by procedure type, care setting, and billing context. You receive their credentials and the agreed turnaround timeline before they begin the review.
Line-item review and analysis
The reviewer conducts a detailed, line-by-line analysis of the billing records, cross-referencing procedure codes, documentation, applicable fee schedules, and the relevant standard for reasonable value in the jurisdiction.
Written report delivered
You receive a written bill review report identifying billing issues found, the reasonable value of the services as billed, and the basis for the reviewer's conclusions. The report is structured to be usable in settlement negotiations and, where appropriate, to support expert testimony on damages.
What You Receive

Deliverables for every bill review engagement

  • Reviewer credentials and match rationale
    Prior to the review beginning, you receive the reviewer's credentials and the basis for their selection — including their relevant experience with the procedure types and billing context in your case.
  • Line-item billing analysis
    A detailed analysis of the billing records submitted, evaluated against applicable fee schedules, procedure code guidelines, and the reasonable value standard for the jurisdiction.
  • Reasonable value determination
    A documented opinion on the reasonable value of the services billed — the number that should be used as the damages baseline rather than the billed amount, supported by the reviewer's analysis and methodology.
  • Identification of specific billing issues
    A categorized list of billing problems identified — upcoding, unbundling, duplication, charges above reasonable value, and any other issues that support a reduction in the claimed damages number.
  • Written report structured for litigation use
    The final report is structured to support settlement negotiations and, where the reviewer is retained as a testifying expert, to meet the requirements for expert opinion disclosure.
When to Use This Service

Cases where bill review changes the damages number

  • High-bill personal injury cases where hospital charges, surgical fees, or extended treatment costs are driving the claimed damages significantly above what the injury mechanism would typically support.
  • Cases involving hospital liens where the lien amount substantially exceeds what a health insurer would have negotiated — and the defense or plaintiff needs documentation of appropriate lien value.
  • Workers' compensation defense where medical cost containment is a litigation priority and the billed amounts exceed the applicable fee schedule.
  • Medical malpractice cases where the claimed cost of remedial treatment or ongoing care is a significant component of the damages claim.
  • Cases where the same treating provider billed for services across multiple settings — emergency, inpatient, outpatient follow-up — and the aggregate billing warrants consolidated review.
  • Defense matters where a damages expert on the plaintiff's side has relied on billed amounts rather than reasonable value, and the defense needs an offsetting expert opinion.
  • Any case where you are simultaneously conducting peer review or IME — bill review coordinates naturally with both and produces a more complete damages picture.
Related Services

Criterion coordinates all three services concurrently when the case calls for it.

Peer Review & Record Analysis →
Combine clinical review with bill review to address both medical necessity and billing reasonableness in a single coordinated engagement.
Independent Medical Examinations →
Pair an IME with bill review to address both the extent of injury and the reasonableness of the treatment costs simultaneously.
Start an Expert Search →
If bill review findings need to be presented at trial, Criterion can place a testifying damages expert to support the opinion.

Ready to request a bill review?

Submit your case and billing records. Criterion will match you with the right reviewer and confirm turnaround within 1 business day.

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