Audit Module
Epic Audit & Sponsor Invoiceability
Transform Epic extracts into audit-ready sponsor invoices. Deterministic invoiceability decisions with full traceability for every line item.
Built for clinical finance analysts at US academic cancer centers. Replace manual spreadsheet workflows with a system designed to withstand sponsor disputes and institutional audits.
The core problem
Epic records what happened, not what should be invoiced.
Without a dedicated audit tool
- Invoiceable charges are missed
- Non-invoiceable charges are billed
- Timepoint mapping is inconsistent
- Sponsor disputes are common
- Audit defense is weak
- Financial leakage goes undetected
Known failure modes we design against
Date → Visit Misalignment
Service dates near visit boundaries cause incorrect cycle/day mapping, leading to billing errors.
Procedure Naming Drift
Multiple charge codes for the same service create inconsistent classification across analysts.
RS ≠ Invoiceable Confusion
Not all Research charges are invoiceable. Without CTA-specific rules, overbilling is common.
Duplicate & Bundled Charges
Epic reversals, duplicates, and bundled charges create silent double-billing risks.
CTA Interpretation Drift
Different analysts interpret the same CTA differently, creating inconsistent invoicing.
Weak Audit Defense
Manual workflows lack the evidence trail needed to defend billing decisions under audit.
How Engram replaces manual audit
Apply MCA principles to financial auditing. Every decision has inputs, rules applied, evidence, output, and confidence signal.
Epic Ingestion & QC
Upload Epic slicer/dicer extracts. System performs automated QC: detects duplicates, reversals, bundled charges, and normalizes procedure concepts.
Visit Assignment
Map service dates to cycle/day using site payment template. Surface ambiguity with confidence indicators for low-certainty mappings.
Invoiceability Determination
For each line item, determine if invoiceable based on CTA, budget grid, and MCA-derived logic. Apply frequency caps, cohort restrictions, and visit constraints.
Export & Invoice
Generate audit-ready deliverables: Excel (cycle/day grouped), PDF audit summary, OnCore-compatible export, and variance reports.
Design Philosophy (Non-Negotiable)
Every invoicing decision must have: Inputs, Rules Applied, Evidence, Output, and Confidence Signal.
Nothing implicit. Nothing untraceable. Nothing "because the analyst decided".
The Audit Workbench
Dense, serious, Excel-native interface. Every Epic line item treated as an auditable case with full traceability.
| Patient | Date | Procedure | Visit | Class | Charge | Invoiceable | Status |
|---|---|---|---|---|---|---|---|
| PT-001 | 2024-03-15 | Brain MRI with Contrast 70553 | Cycle 3 Day 1 | RS | $4,200 | $4,200 | Auto |
| PT-001 | 2024-03-15 | Lab Panel - Comprehensive 80053 | Cycle 3 Day 1 | SOC | $245 | - | Auto |
| PT-001 | 2024-03-14 | PK Blood Draw 36415 | Cycle 3 Day 172% | RS | $89 | $89 | Review |
| PT-002 | 2024-03-12 | CT Chest 71250 | Screening | RS | $1,850 | $1,850 | Auto |
| PT-002 | 2024-03-12 | Bone Marrow Aspirate 38220 | Screening | RS | $3,200 | - | Conflict |
| PT-003 | 2024-03-10 | ECG 12-Lead 93000 | Cycle 1 Day 1 | SOC | $156 | - | Auto |
| PT-003 | 2024-03-10 | Physical Examination 99204 | Cycle 1 Day 1 | SOC | $320 | - | Auto |
| PT-004 | 2024-03-08 | Drug Administration 96413 | Cycle 2 Day 888% | RS | $890 | $890 | Review |
Brain MRI with Contrast
70553 | PT-001
Epic Source
Visit Assignment
Service date 2024-03-15 mapped to Cycle 3 Day 1 based on site payment template window.
Invoiceability Determination
MCA-Style Decision Trace
For any billed or rejected item, the system shows the complete decision chain. This is mandatory for audit defense.
Epic Source Row
Raw data preserved exactly as extracted
Normalized Procedure
Standardized procedure concept mapping
Visit/Timepoint
Mapped to protocol schedule
CTA Rule Applied
Invoiceability determination logic
Pricing & Overhead
Final invoiceable amount calculation
Final Decision
Output with confidence and any flags
Sponsor Dispute Defense
Every charge backed by documented logic chain. No more "because we decided" explanations.
Internal Audit Ready
Institutional auditors can inspect any decision with complete traceability.
Regulatory Compliance
21 CFR Part 11 compatible logging. Full version history for all rules.
Variance & Cost-Savings Analysis
Quantify recovered revenue, avoided dispute risk, and identify patterns indicating systemic leakage.
Missed Invoiceable Charges
Research charges not previously identified as invoiceable
| Item | Reason | Amount |
|---|---|---|
| PK Blood Draws (12 instances) | Incorrectly classified as SOC | $8,940 |
| Protocol-required Labs | Missing from manual audit | $18,240 |
| Imaging Studies | Visit mapping errors | $15,200 |
Overbilling Prevention
Charges that would have been incorrectly invoiced
| Item | Reason | Amount |
|---|---|---|
| SOC Procedures | Misclassified as research | $6,240 |
| Duplicate Charges | Epic reversals not caught | $3,450 |
| Frequency Cap Exceeded | Budget limit violations | $3,200 |
Systemic Patterns Detected
Recurring issues that indicate process improvements or training needs.
Visit Boundary Issues
HighService dates falling on visit window boundaries causing inconsistent mapping
Charge Code Drift
MediumSame procedures billed under different CPT codes across patients
Lab Panel Bundling
MediumIndividual lab tests billed separately instead of as panels
Measurable Impact
Engram Clinical is deployed at leading academic medical centers processing thousands of clinical trial charges monthly.
Previously missed billable items identified and invoiced correctly
In manual reconciliation effort per protocol
Every decision traceable to source documents
From Epic extract to sponsor invoice
"We went from spending 2 weeks per protocol on reconciliation to 2 days. The variance detection alone paid for the system."
"For the first time, we can actually explain to sponsors exactly why each line item is or isn't billable. No more black box."
Ready to transform your clinical trial billing?
See how Engram Clinical can automate your Epic-to-invoice workflow with a personalized demonstration using your own protocol data.
From contract to first protocol processed
No direct system integration needed
Volume discounts for enterprise