How the audit actually works.
No black box — here's exactly what ClearCharge checks and why, in plain language.
1. Line-by-line parsing
When you upload a photo or PDF of an itemized bill, ClearCharge extracts the text on-device (using pdf.js and Tesseract.js OCR, entirely in your browser) and does a best-effort pass to pre-fill the description, billing code, quantity, and charge for each line — you review and correct this draft before analyzing. You can also skip upload and paste the lines yourself. Itemized statements (not the one-page summary bill) contain this level of detail; if your provider only sent a summary, you can request the itemized version, which they're required to provide.
2. Benchmark price comparison
Each billing code is checked against a benchmark price fetched from ClearCharge's tiered backend — a live Medicare Physician Fee Schedule API where available, falling back to a cited reference table of published 2025–2026 CMS national Medicare rates for codes the live API doesn't cover (see "Data Sources" below). Flagged lines show a small badge indicating which tier supplied the benchmark. If a line is priced more than 50% above that benchmark, it's flagged as a potential overcharge, along with an estimate of the dollar amount in question. Anesthesia (CPT 00400) is an exception: anesthesia billing uses a base-unit-plus-time-unit formula rather than a flat per-unit rate, so it isn't price-benchmarked the same way — for that code, the audit focuses on the No Surprises Act check below instead.
3. Duplicate & quantity checks
The audit looks for the same billing code appearing more than once (a common billing error) and for codes that are normally billed only once per visit but appear with a quantity greater than one — both are flagged for you to verify with the provider.
4. No Surprises Act screening
If a charge comes from an ancillary provider type (like anesthesiology) at a facility you confirm was in-network, and it's a provider you didn't personally choose, the audit flags a potential violation of the federal No Surprises Act, which generally protects patients from being balance-billed beyond in-network cost-sharing in these situations. Read the official rules at cms.gov/nosurprises.
5. Dispute letter drafting
Every flagged and reviewable line item is compiled into a plain-language letter requesting an itemized re-review, correction of errors, and adjustment to a reasonable and customary rate — citing the No Surprises Act where relevant, with a 30-day response request.
Where the benchmark prices come from
ClearCharge resolves each billing code's benchmark price through three tiers, tried in order of authoritativeness. If a higher tier can't answer for a given code, the audit automatically falls back to the next one — so the analyzer always returns a cited benchmark and never breaks.
1. Live Medicare Physician Fee Schedule API (active)
For professional/procedure codes — like ER visit levels, X-rays, EKGs, and IV hydration — ClearCharge's backend calls a real-time Medicare Physician Fee Schedule API (Localis / medicalfeeschedules.com) that computes the current, citable CMS rate on the fly from the published RVU and conversion-factor files, optionally locality-adjusted. Each amount returned this way is tagged with a "Live CMS data" badge next to the flagged line item.
2. Cited CMS Clinical Lab Fee Schedule reference data (fallback for lab codes)
The live Physician Fee Schedule API covers professional/procedure codes only — it does not include Clinical Lab Fee Schedule (CLFS) codes such as Complete Blood Count (85025) or Comprehensive Metabolic Panel (80053). For these, and as a general-purpose fallback if the live API is ever unreachable, ClearCharge uses a small table of cited 2025–2026 CMS national Medicare reference rates. Amounts from this tier are tagged with a "Reference data" badge.
| Code | Service | Benchmark | Source |
|---|---|---|---|
| 99284 | ER Visit, Level 4 | $410 | coveredusa.org |
| 85025 | Complete Blood Count | $9 | coveredusa.org |
| 80053 | Comprehensive Metabolic Panel | $11 | coveredusa.org |
| 71046 | Chest X-Ray, 2 Views | $33 | careroute.ai |
| 96361 | IV Hydration, per additional hour | $13 | buyandbill.com |
| 93000 | EKG | $15 | careroute.ai |
| 36415 | Venipuncture | $9 | medsolercm.com |
| 00400 | Anesthesia Services | Not price-benchmarked (NSA check only) | — |
These reference rates are used whenever a code falls outside Physician Fee Schedule coverage (e.g. lab codes) or if the live API call fails for any reason — including 85025 and 80053 above, which are Clinical Lab Fee Schedule codes and are not part of the Physician Fee Schedule.
3. Turquoise Health Clear Rates (architected, not yet active)
ClearCharge's backend is already architected with a top-priority slot for Turquoise Health's Clear Rates API, which combines hospital and payer price-transparency files, claims benchmarks, and Medicare fee schedules — the best available source for full hospital-facility, chargemaster, and negotiated-rate coverage, not just Medicare reference rates. This tier is not live yet: Turquoise Health has no self-serve signup, and access requires contacting their enterprise sales team for API credentials. The moment that access is arranged, this tier will be enabled and will automatically take priority over the other two for any code it covers.
A note on this prototype
This is a working demo built to show the concept end-to-end. It already includes a real backend that fetches live, citable Medicare Physician Fee Schedule rates (see "Data Sources" above) rather than a purely static dataset. A full production version would still need a HIPAA-compliant data pipeline (encrypted storage, business associate agreements, access controls) and, ideally, enterprise access to a comprehensive hospital/chargemaster data source such as Turquoise Health's Clear Rates — architected above but not yet active — for full facility and negotiated-rate coverage beyond Medicare reference rates. Nothing entered into this demo is stored, transmitted, or shared — the entire audit, including any file upload and OCR, runs in your browser; the bill's billing codes are sent to ClearCharge's own benchmark backend only to look up reference prices, never to a third party, and are not logged or retained.
Common questions
Is this legal or financial advice?
No. ClearCharge is an informational and administrative tool that helps you identify potential billing errors and draft a dispute letter. It does not provide medical, legal, or financial advice, and the generated letter should be reviewed before sending. For complex disputes, consider consulting a licensed patient advocate or attorney.
Is my data safe?
In this prototype, the entire audit runs client-side in your browser — nothing you type is stored on a server or transmitted anywhere. A production version handling real patient data would require a HIPAA-compliant pipeline with encryption, access controls, and business associate agreements with any vendors involved.
What bill sizes does this work for?
Any size. Because the audit is fully automated rather than relying on human reviewers, ClearCharge can check a $200 urgent-care bill just as easily as a $50,000 hospital stay — unlike advocate services that typically require a $5,000+ minimum to make the human-review model worthwhile.
How is this different from Goodbill or Resolve?
Goodbill and Resolve are human-reviewed negotiation services that typically take 10–25% of whatever they save you, and often require a minimum bill size (Resolve requires $5,000+). ClearCharge's core audit is free and unlimited regardless of your savings amount or bill size, and returns results in minutes instead of weeks because the review is automated.
How is ClearCharge free? How do you make money?
The core bill audit — unlimited itemized bill checks and dispute-letter generation — is free for everyone, with no sign-up required. It's supported by ads shown on the results and letter pages (clearly labeled "Advertisement," and never disguised as part of the audit itself). If you'd rather not see ads, the optional Plus plan ($4.99/month) removes them and adds saved bill history and priority processing. ClearCharge also earns revenue from Advocate/Pro subscriptions for patient advocates and nonprofits doing bulk audits, and from Enterprise/API licensing fees paid by HSA/FSA administrators and employer benefits platforms that embed ClearCharge white-label into their own products (those embedded, licensed experiences don't show ads at all). See the full breakdown on the pricing page.
What if my bill doesn't have any errors?
Then you'll get a clean report — line items marked "No issues detected" — which is useful too, since it confirms the charges are within a typical range before you pay. Not every bill has an error; the 80% error-rate statistic reflects that most, not all, bills have at least one issue.
See it in action
Try the analyzer with a sample bill or your own — it only takes a couple of minutes.
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