You find out when it comes back
The claim is submitted, then returned. Only then do you learn what was wrong. Fixing it and resubmitting costs another round of everyone's time.
Insurance Claim Review
Japanese
About ¥400,000 a month in checking costs — or from ¥50,000.
Rethink what claimchecking costs you.
All we take from you is the electronic claim file. We cross-check it against the national fee schedule data and return everything that looks under-billed or likely to come back, grouped by chart number.
Your staff review only the flagged items. Less time spent checking, and less labour cost behind it.
*The ¥400,000 figure is an estimate, assuming the review takes the equivalent of two staff members (about ¥200,000 each per month). The actual cost varies by clinic.
No pushy follow-up. Ask us anything without committing to a contract.
Departments we
check in-house5deptsInternal medicine, psychosomatic, dermatology, pediatrics, OB-GYN
check in-house5deptsInternal medicine, psychosomatic, dermatology, pediatrics, OB-GYN
Review rules
in live use20+rulesRunning every month on our own claims
in live use20+rulesRunning every month on our own claims
What the
check costsFrom ¥50,000per monthFirst month checked free
check costsFrom ¥50,000per monthFirst month checked free
All we take from youClaim file onlyUKE format, both Shaho and Kokuho. No charts, no consent forms.
Common Problems
You know you should check.
There just isn't time.
There's no time before the deadline
Everyone agrees the claims should be reviewed. But the rest of the work doesn't stop during those few days, so they go out after a quick skim.
You're leaving earned revenue behind
The worry is always "did we bill something we shouldn't have." Nobody flags the opposite: items you qualified for and never claimed.
Only one person can do it
What to look for lives in one experienced person's head. When they take leave, the review stops. There is no plan for teaching the next person.
We run a clinic ourselves. All four of these are problems we hit in our own practice first.
Why HUMEDIT
Three reasons clinics choose us
01We review our own
We review our own
claims every month
Hiro Clinic, run by Fukubikai Medical Corporation, covers internal medicine, psychosomatic medicine, dermatology, pediatrics and OB-GYN. We review those claims ourselves, every month. Where billing gets missed and where claims come back — we learned it from our own data, not from a manual.
02The fee schedule sits
The fee schedule sits
in data, not in memory
We load the fee schedule master files published by the Ministry of Health, Labour and Welfare — diagnoses, procedures, drugs and comment codes — and judge against those. Nothing is hard-coded from memory, so a revision means swapping the data, not rewriting the tool.
03
AI takes the grunt work, so it starts at ¥50,000
Reading files and cross-checking them against the masters is work a machine does well, so we let it. The time that frees up goes into the parts that need a human — judgement calls and explaining the results to you.
Services
What we actually do
We don't only look for what you billed in error. We also look for what you earned and never billed. You get both halves — the defensive side and the recovery side — in one list.
1. We read the claim file as it is
Send us the same UKE file you submit. Shaho and Kokuho are both supported. You don't need to prepare anything special for the review.
2. We find what you under-billed
Add-ons and management fees you qualified for but didn't claim. Left alone, you lose that amount again the following month, and the month after.
3. We flag what is likely to come back
Items where the requirements may not be met, with the reasoning attached. Fixing them before submission removes the rework that follows a returned claim.
4. We check diagnoses against billing
Is there a registered diagnosis supporting each item billed? Are "suspected" diagnoses still sitting there months later? Is the first-month diagnosis list tidy?
5. We hand it over in fix-order
A list of chart numbers and what to change, sorted with the return-risk items first. Your staff work down the list from the top.
6. Revisions mean swapping data
Because the tool reads the published fee schedule data, a revision doesn't mean rebuilding it. We swap the data and reflect the changed requirements in the settings.
What We Check
What a review
actually turns up
None of this happens because someone was careless. The requirements are detailed, the volume is high, and it all lands at the end of the month. Given those conditions, anyone would make these.
Everything below is the kind of thing we find in our own clinic's claims and correct every month.
The patient doesn't meet the conditions
Some items are limited to patients meeting set conditions, such as age. We check whether anything was billed outside those limits.
An eligible add-on is missing
You met the requirements and didn't bill it. Because it isn't an error, nobody points it out. It simply doesn't arrive.
It exceeds the allowed range
Some items have limits on how often or how much can be billed. We confirm each one falls inside its range.
Billing and diagnosis don't line up
Some items require a matching diagnosis on file before they can be billed. We check that the pairing holds.
"Suspected" diagnoses left standing
A suspected diagnosis carried for months on end. Confirm it, or close it out. Left untidy, the basis for the billing falls apart.
Point values and requirements change at every revision. This tool doesn't memorise them — it reads the fee schedule data published by the Ministry of Health, Labour and Welfare and judges from that. At a revision, we swap the data.
Where our responsibility ends
What we provide is the review. Confirming and submitting the final claim stays with the medical institution. We do not warrant that your billing is correct. What we hand over is the material you need in order to decide, with the reasoning attached.
Plans
Start with the free check. Three plans after that.
Free check
¥0
For directors who wantto see where they stand
- One month of claims reviewed
- List of under-billed items
- List of return and reduction risks
- Diagnosis-to-billing check
- Fix list by chart number
- Report plus a 15–30 min walkthrough
- Monthly review is a paid plan
Standard
¥50,000 / month, excl. tax¥55,000 incl. tax
Turn the monthly reviewinto a routine
- Monthly claim review
- Under-billing and return risks flagged
- Diagnosis-to-billing check
- Fix list by chart number
- Fee schedule data kept current
- Building claim entry data
- Monthly meeting
Pro
¥100,000 / month, excl. tax¥110,000 incl. tax
Review, plus hand offthe data entry
- Everything in Standard
- Entry data built from your records
- Output your billing system can import
- Multiple departments and payers
- Settings reviewed at each revision
- Monthly meeting (30–45 min)
| What's included | Free check | Standard | Pro |
|---|---|---|---|
| One month reviewed, with fix list | ● | ● | ● |
| Review every month | — | ● | ● |
| Diagnosis-to-billing check | ● | ● | ● |
| Multiple departments and payers | 1 dept only | ● | ● |
| Entry data built from your records | — | — | ● |
| Monthly meeting | Walkthrough only | — | ● |
Setup is included in the monthly fee. There is no separate onboarding charge. Minimum term is six months.
Quoted separately
Bulk review of past months, development to read record formats we don't yet support, integration work on the billing system side, and simultaneous rollout across multiple sites are quoted separately.
Flow
From enquiry to running
01
Send us an enquiry
Tell us your departments and the name of the billing system you use. That's all we need from you at this stage.
02
We review one month, free
Send the UKE file you submitted and we review it. We agree the handover method with you in advance, before anything is sent.
03
We walk you through the results
You get the under-billed items and the at-risk claims as one list, plus a 15–30 minute walkthrough. No jargon.
Everything above is free
04
Contract and monthly review
From the following month, results arrive timed to your submission schedule. Deciding in advance who applies the fixes is what makes it work from month one.
From enquiry to receiving the review usually takes about five business days.
Our Approach
It's what we do in our own clinic, every month.
Unglamorous work, repeated every month.
Read the claim file, cross-check it against the fee schedule data, output what looks wrong with a chart number attached. Next month, do it again. There is nothing clever about it. We have simply kept doing it, month after month. What we hand you is that process itself.
FAQ
Frequently asked questions
What do we need to prepare for the review?
Only the UKE file you submitted. Both Shaho and Kokuho are supported. You don't need to produce anything extra for us. If you can export it split by department, accuracy improves.
We already review in-house. Doesn't this overlap?
It doesn't. A person notices what looks unusual; a machine notices what breaks a rule. They find different things. You don't need to stop your in-house review — the machine passes over every record, and your staff spend their time on the calls that need judgement.
Can you guarantee our billing is correct?
No, and we don't claim to. Our role ends at telling you "this looks under-billed" and "this may not meet the requirements," against the fee schedule data and the stated conditions. The final decision on what to submit stays with the medical institution. We always attach the reasoning so you can make that decision.
Does this mean fewer returned claims?
Fewer of the ones you could have caught first. But claims come back for reasons beyond the stated requirements, including the payer's own assessment. We can't promise they stop. What we reduce is the share that a requirements check would have prevented.
How do you handle fee schedule revisions?
The tool reads the fee schedule data published by the Ministry of Health, Labour and Welfare rather than storing the values. At a revision we swap that data and reflect the changed requirements in the settings. There is no rebuild each time.
Which departments do you cover?
In our own clinic we review internal medicine, psychosomatic medicine, dermatology, pediatrics and OB-GYN every month. Other departments work too, because the same fee schedule data and requirements apply. What matters differs by department, so start with a free conversation.
Will our billing staff lose their jobs?
No. What shrinks is the hours spent eyeballing every record. Judgement and patient contact stay with people. If anything, the checks that live in one experienced person's head become something you can keep and hand on.
Can you go back over previous months?
Yes. A bulk review of past months is quoted separately from the monthly service. We'd suggest running the free check on the most recent month first, seeing how much it surfaces, and deciding from there.
How long until we see an effect?
You get the first review immediately. How much under-billing you actually recover, and how far returns drop, depends on how the fixes get applied inside the clinic. Decide in advance who does that and it starts working from month one.
Is there a minimum term?
Six months. What surfaces varies month to month, so it takes a little time before the pattern is readable. From month seven you can end it at any point.
Can we change plans later?
Yes. You can start on Standard and move to Pro, or the other way round.
When are we invoiced?
We close at month end and invoice for payment by the end of the following month. Usage for the current month is billed at month end and settled by the end of the next.
Document
Prefer to read first?
We will send you a document covering what the review does, what it costs, and the kind of findings we hand back. It is written to be passed around the clinic, so feel free to ask for it even if you are only looking.
- How the review works, and what each month looks like
- Pricing, and what the free review covers
- Examples of what we actually flag (missed charges, likely returns)
- How the claim file is handed over
We use what you enter only to send the document and to reply. No pushy follow-up.
Free Check
Start with one month.
See what's in there.
Tell us your departments and the billing system you use. We'll review one month of claims and send back the under-billing and the return risks, free of charge.
- Items you qualified for and didn't bill
- Billing at risk of return or reduction
- Gaps between diagnosis and billing
- A fix list in priority order
- Every finding tied to a chart number
We take up to ten of these a month. We'll reply first on whether we're able to help.
Company
HUMEDIT Inc.
Built on Hiro Clinic, operated by Fukubikai Medical Corporation. What we offer comes out of running a medical practice.
- Company
- HUMEDIT Inc.
- Address
- UETAKE Bldg. 3F, 1-3-6 Nishikanda,
Chiyoda-ku, Tokyo 101-0065, Japan - Founded
- May 23, 2006
- Representative
- Kotaro Oka
- Affiliation
- Fukubikai Medical Corporation (Hiro Clinic)
- Accreditation
- CAP accredited / Japanese Society of Legal Medicine / White Company certification
