Physician-signed UR plan
Every participating hospital must have a utilization-review plan with physician participation. StatusProof ensures the determination is reviewed and signed by a licensed physician advisor.
The most defensible inpatient status determination a hospital can get.
StatusProof assembles a criteria-mapped, physician-signed medical-necessity determination for every short-stay or observation-eligible admission — checked against Two-Midnight Rule, InterQual/MCG, and 42 CFR §482.30 before a licensed physician advisor releases it.
Every element of 42 CFR §482.30Two-Midnight + InterQual/MCG criteria mappingPhysician advisor review & signaturePeer-to-peer & appeal packages included5-business-day SLA
Why determinations fail
A single wrong status can cost your hospital 78% of reimbursement.
When a patient is admitted but not clearly inpatient, the status decision — inpatient vs. observation — swings reimbursement by 30–50%. One documented case: a hospital billed $147,542, was paid $58,187 as inpatient, then had it re-determined to outpatient and cut to $13,174 — a 78% haircut after the fact.
Most hospitals run this by hand, from memory, with a case-management nurse and an ad-hoc physician advisor. The rules are federal, technical, and unforgiving: Two-Midnight Rule, InterQual/MCG criteria, and 42 CFR §482.30 require a physician-signed determination. Payers are tightening — Aetna's November 2025 policy pays observation rates for MA inpatient stays that miss MCG criteria.
StatusProof exists to close that gap with a single, exhaustive standard applied identically to every case.
78%
reimbursement loss on a single wrong status determination
The benchmark
Measured against the letter of the regulation — subsection by subsection.
We do not summarize the law and hope. Every determination is scored against a versioned rule pack tied to the exact text of 42 CFR §482.30, Two-Midnight Rule, and InterQual/MCG criteria. These are the provisions each case is held to.
Two-practitioner committee
The UR committee must include at least two physicians. Our process mirrors this with a physician advisor and a clinical reviewer.
No-medical-necessity determination
A determination of no medical necessity must be made by a physician after consulting the treating doctor. StatusProof documents this consultation.
Two-midnight expectation
The physician's expectation of a stay spanning two midnights is documented and criteria-mapped. If not met, observation status is recommended.
Level-of-care criteria
Each case is mapped to InterQual or MCG criteria for inpatient vs. observation level of care, with citations.
Records and appeals
A complete record of the determination, including peer-to-peer scripts and appeal packages, is provided for every case.
How a determination is built
Intake to physician release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A licensed physician advisor signs every release. That order is never reversed.
01
Delinquency Gap Scan
Upload the EHR clinical picture and admission data. We return a free completeness read: which criteria elements and documentation you already have, and which are missing.
02
Clinical data extraction
As your authorized clerical agent, we extract the clinical picture from the EHR — notes, labs, vitals, medications — and build a structured case file.
03
Criteria mapping
The clinical data is mapped to Two-Midnight Rule and InterQual/MCG criteria using deterministic rules and AI-assisted drafting.
04
Deterministic completeness gates
The two-midnight expectation is verified; criteria citations are checked; the physician consultation is documented; any missing element blocks release.
05
Physician advisor review
A licensed physician advisor reviews the determination, makes the final judgment call, and signs the record. High-value or complex cases route to a specialist.
06
Delivery
You receive the determination: criteria-cited rationale, physician-signed record, peer-to-peer script, and appeal package — ready for the hospital to use.
The bar we hold
Rigor you can measure.
100%
Physician-signed
No determination ships without a licensed physician advisor's signature.
5 days
Standard SLA
From complete intake to released determination.
<1%
Critical-defect target
Tracked against a gold-standard determination library.
3
Criteria sources
Two-Midnight Rule · InterQual · MCG, every applicable case.
Why StatusProof
Built to be the most defensible option a hospital has.
Documentation-complete, by design
The deliverable is completeness itself — every regulatory element and criteria citation accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a regulatory requirement.
In its lane, on purpose
We prepare documentation and run searches as your clerical agent. We never give legal advice, contact the patient, or make independent medical decisions.
Engagement
Flat fee per reviewed case and per appeal. No hourly billing, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
- A free Delinquency Gap Scan before you commit — see exactly what is missing.
- One flat fee per reviewed case; disclosed pass-through costs for complex cases.
- Optional contingency on recovered denials (20–40% of recovered amount, market norm).
- Optional Sale Continuity Add-on for peer-to-peer and appeal packages, pre-dated to your denial timeline.
FAQ
Questions, answered precisely.
Is StatusProof a law firm?
No. StatusProof, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Physician advisor review is available and recommended for all cases.
Do you contact the patient or make medical decisions?
Never. StatusProof is not a healthcare provider and does not contact patients or make independent medical decisions. The hospital remains the treating entity and the party responsible for all clinical decisions.
What makes a determination 'complete'?
Completeness is defined by the regulation: the physician-signed UR plan, two-midnight expectation documented, InterQual/MCG criteria mapped, physician consultation recorded, and appeal package ready. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to a physician-signed determination. The free Gap Scan is returned much sooner and tells you exactly what is still needed.
How are you priced?
A flat fee per reviewed case, plus disclosed pass-through costs for complex cases. No hourly billing and no percentage of any recovered amount unless you opt for contingency on denials.
See what's missing before it costs you 78% of reimbursement.
Start with a free Delinquency Gap Scan. Send your EHR clinical picture and admission data and we'll return a completeness read against every subsection of 42 CFR §482.30 and Two-Midnight Rule.
Documentation-completeness service · not legal advice · the hospital makes all clinical decisions.