The Layer Nobody Audits cover image
CLAIMS RETRIEVAL OVERSIGHT Case study

The Layer Nobody Audits

A worked example of the reporting The Records Company runs on any book of business: where records requests fail, on every side of the transaction, who caused it, and what it costs.

27,111

Requests analyzed across a seven-month sample

270,150

PROCESSING NOTES READ, LINE BY LINE

61

OF REQUESTS RUN BY THE DATAVANT FAMILY

321

FALSE "NO RECORDS" ANSWERS PROVEN WRONG

This is a sample analytics case study, one firm's complete retrieval operation, 27,111 requests and 270,150 processing notes over seven months, traced to its source. Nothing here is modeled or estimated; it is the operating record, read line by line. A request can fail on the way in, on the way through, or at the provider, and a panel making a vendor decision deserves to know which, and who is telling them.

Request intake

Incomplete or inaccurate requests create risk, so we check every request before it goes out. Only 334 requests, about 1.2%, carried a real input issue, caught and corrected before it cost claim time.

EXHIBIT 1 · FIRM-SIDE INPUT ISSUES CAUGHT

334 requests, 1.2% of the book

Authorization or attestation detail gap 132
Wrong or mismatched patient detail 131
Wrong facility, entity, or routing target 81

Source identification

The right source isn't always the obvious one. About one in four requests, 6,193 of 27,111, ran through a release-of-information copy service rather than the provider directly. A single corporate parent, Datavant, already controls most of the platform layer a panel's retrieval depends on.

EXHIBIT 1 · REQUESTS ROUTED, BY NAMED PLATFORM

Ciox 625 ChartSwap 376 Datavant 273 MRO 259 MediCopy 182 Verisma 147 Sharecare 110 HealthMark 49

Green marks the Datavant-owned family (Ciox, Datavant, ChartSwap), 61% of every named-platform request in this book.

CONSOLIDATION DIDN'T BUY RELIABILITY

37%

DATAVANT TROUBLE RATE

36%

CHARTSWAP TROUBLE RATE

Better than one in three requests, either way. Two independents scored worse. The family was no better for its scale.

Platform routing

Breaks in process create silent failure. A bounce is the signature move: the platform refuses to route a request it should handle and sends the requester in a circle. It happened on 1,057 requests, none about whether records exist, all about handling.

EXHIBIT 3 · COPY SERVICE PROCESS FAILURES

Lost the request on their own system 218
Bounced it back: "we don't handle this" 113
Demanded prepayment before any work 38
Cancelled as unable to fulfill 3
Sent an incorrect redirect 1

Quality & delivery

Issues surface late, when they cost more. A "no records" answer is not neutral: it closes a line of inquiry and lets a reserve assumption drop. Of 2,570 received, we challenged 805 with proof of treatment or a forced second search. At least 321 came back with records that existed all along, more than seven in ten of them on a Datavant-owned platform.

PROBLEMS TRIPLE THE WAIT

20

MEDIAN DAYS CLEAN REQUEST

60

MEDIAN DAYS THIRD PARTY FUMBLED IT

+40 business days, roughly eight calendar weeks, on the same record, while the claim behind it stayed open.

Financial impact

Hidden failures cascade into real cost. Providers that refuse any electronic signature forced a re-sign on 635 requests, a provider policy, predictable and fixable with the right intake routing. Provider performance otherwise varies enormously: an 82-business-day median at one facility against a 10-day median at another is a routing decision a claims team can make on evidence.

What went wrong The Takeaway Value
Platform bounced or misrouted (1,057 reqs.) Resent free, part of the original fee absorbed
False "no records" (321 reqs.) Challenged and overturned claim files saved
Wet-ink signature rule (635 reqs.) Routed and escalated at intake delay avoided
12,648 resubmissions, total Never billed back to the client $198K–$379K

What went wrong

Cancelled after the work was done

The fix

Confirm the case is active before sending

Recovered

$207K

What went wrong

Sent to the wrong provider or place

The fix

Verify provider and location at intake

Recovered

$112K

What went wrong

Duplicate and double-billed requests

The fix

One request per matter, one channel

Recovered

$47K

What went wrong

Wrong name, date of birth, or dates

The fix

A 30-second check before submitting

Recovered

$45k

What went wrong

Recoverable each period

The fix

Most of this repeats until the process changes

Recovered

~$362K

Every number in this report depends on one thing: the party doing the measuring has no stake in what is being measured. In a panel decision, that is not a detail. It is the whole question.

THE LAYER NOBODY AUDITS

Why ownership decides who can measure this

The party best positioned to score this layer owns none of it, and competes with none of it.

Independent, reads the whole record

  • Reports its own platform's failures

    Nothing to protect, nothing to flatter

  • Scores the firm, provider, and platform

    The same hand, the same standard

  • Surfaces the false "no records"

    Least likely to find it, best positioned to catch it

  • Refreshed scorecards, every quarter

    Every platform the panel touches

Platform-owned vendor

  • Bounces and losses invisible outside its system

    A self-serve portal never looks inside its own process

  • Evaluates within its own corporate ecosystem

    Ontellus, Ciox, ChartSwap, Datavant: one family

  • No incentive to surface its own trouble rate

    Reporting naturally favors its own operations

  • One slice of the path, never the whole record

    A platform never reports its own mistakes

A framework for evaluating retrieval

The case generalizes into scorecards any panel can run on its own book, for a single client or the whole book of business.

FIRM-SIDE QUALITY

Caught before it costs claim time

Input issues the firm can act on once someone shows them.

COPY-SERVICE SCORECARDS

Trouble rate, bounce rate, false no-records

For every platform on the panel, Datavant family included, refreshed each quarter.

PROVIDER SCORECARDS

Turnaround, wet-ink rules, no-records rate

By facility, so claim teams route and escalate on evidence.

Read the full case study

The complete 12-page analysis, every exhibit, and the methodology.

About The Records Company

Better records. Better outcomes.

The Records Company is a national medical-record retrieval partner serving legal, insurance, healthcare, and government clients. It pairs disciplined intake with transparent status on every request and a fully auditable record of the work, so clients can see at any moment exactly where each request stands and what it has cost. This case study is based on a real, anonymized client engagement, published for educational purposes.