Sample Evidence Report

This is what
proof looks like.

Below is a worked example of the report inside Verity Claims™ Evidence: the findings, the documents behind them, and the evidence graph that ties your bill, EOB, claim, and coverage rules together.

The patient, provider, and every dollar figure on this page are fictional, made up to show the report's structure. Your report is built from your documents.

Clinical episode · illustrative
Example Regional Medical Center
Emergency department visit, insured, in-network · date of service March 14
Billed
$2,410.00
You were asked to pay
$941.62
Flagged by the audit
$611.40
Findings
4
The findings

Four findings, each traced
to the documents.

Every finding points to the line on your bill and the line on your insurance statement it came from, and names the reference data it was checked against, so the person reading your dispute can check the math themselves.

01
Bundled service billed separatelyCPT 96372 with 99284

A therapeutic injection was billed as its own line even though NCCI bundling rules include it in the emergency visit as coded. Unbundling inflates the bill by the full price of the second line.

Basis · Two bill lines for one visit, compared against the NCCI bundling pair for those codes, no modifier on the claim

$187.00
Strong
02
Duplicate charge for one serviceCPT 85025 × 2

The same complete blood count appears twice with identical code, date, and units. The claim shows one adjudicated unit.

Basis · Bill lines 7 and 12 against the claim's single adjudicated unit

$96.40
Strong
03
Units above the published limitCPT 96361, 4 units

Billed hydration units exceed the Medically Unlikely Edit value for this code in this setting: more hours of hydration than the visit lasted.

Basis · Units on the bill, compared against the CMS MUE value for the code and the visit's documented duration

$214.00
Documented
04
Bill and EOB disagree on what you owePatient responsibility

The provider's bill asks for more than the insurer's EOB says you owe after the plan discount. The difference has no adjudicated basis on the claim.

Basis · EOB patient-responsibility field reconciled line-by-line against the bill's total

$114.00
Documented

Findings marked "needs justification" carry no dollar demand: the report asks the provider to document the charge instead of asserting an overcharge it can't prove. Honest math is the point.

The evidence graph

Four documents,
one connected story.

Your bill → Your EOB
Every line reconciled: billed, allowed, plan paid, you owe
Your EOB → The claim
Adjudication checked against what was actually submitted
The claim → Coverage rules
Each code tested against NCCI edits, MUE limits, and fee schedules
Coverage rules → Your dispute
Every finding points to the bill line and EOB line it came from
The $99 report

The report is the proof.
The package is the plan.

Verity Claims™Evidence turns the report into a dispute you can act on. You review, sign, and submit everything yourself, and you keep 100% of whatever you recover. If the scan flags errors the package can't document from your bill and insurance statement, you get a refund.

›The evidence report you see here, for your actual bill
›A dispute letter that lists each finding, ready for your review and signature
›A line-by-line worksheet with the dollar math shown
›Certified mailing of your approved package
›Deadline tracking for the response windows that apply
›90 days of re-analysis on whatever the provider sends back

See what your own bill says.

Start my free auditSee pricing

No card required · you keep 100% of anything you recover