Your Rule 16 arbitration summary. In under two minutes.
Upload the packet as it arrived. Every disputed service comes back by date, type, amount billed and amount owed.
- Priced against the NJ PIP fee schedule and its daily caps
- A typical packet runs 80 to 120 pages, priced without a keystroke
The engine never invents a number. The line is flagged for review, and our NJFS and UCR lookup resolves the benchmark that governs when the schedule is silent.
No commitment. You do not pay us for PLIGA, withdrawn, or lost cases.
Bills, EOBs, AOBs and records in one pile, out of order.
You upload the same folder. Eighty pages or a hundred and twenty, every billed line comes back priced and cited in under two minutes.
Talk to the firms already filing with it.
They run live NJ PIP arbitration files through this system. Packets arrive the way they always did, unsorted, and the reconciliation comes back the same day. The attorney still decides what gets filed and what gets conceded.
Came on afterwards, on the same system and the same per-case rate. Nothing about the way their office prepares a file had to change, and no one had to be hired to run it.
Ask, and we will arrange a call with a firm already running this on live PIP files. No names on the page, because of the work they do.
Ask for a reference callSend one packet.
Keep going only if it holds up.
Run my first packet freeBuilt by the paralegal who filed about five thousand of these by hand.
PIP Engine encodes a process that ran for eight years before any of it was software. Its rules were worked out on real files at a New Jersey personal-injury firm, on behalf of providers who had treated injured people and had not been paid properly.
That last figure is an approximation, because he counted the filings and not the mistakes. It only fell that far after he stopped reading from the file and typing into the filing form, and moved every value into one checked source first. The engine runs on the same principle: read the documents once, put every extracted value in front of a human to confirm once, then reuse the confirmed values everywhere they are needed. The full procedure, including the two documents that gate a case before any of this matters, is written up in how to file a NJ PIP arbitration demand on Forthright.
Every figure traces back to the published fee schedule.
Not an argument about what the carrier ought to have paid. A number an arbitrator can check against a document. The schedule prices the code, the daily maximum is applied to the date of service, and the carrier’s own explanation of benefits says what was paid against it.
Every priced line names the rule that produced it and the two documents behind it, the claim page the charge was read off and the treatment note that says the service happened. A line the engine cannot match to a scheduled price is flagged for review rather than filled in with a number nobody can stand behind. When a figure is challenged, you open the page it came from and point at it. Those are the three things Rule 16 asks for: the disputed services by date, type, amount billed and amount owed, the issue behind each amount, and the document evidencing it.
Billed and Paid are on screen. The fee-schedule rate, what is still outstanding, the rule behind each figure and the two document columns sit to the right. Scroll the sheet sideways to reach them, and down for every line.
| 1 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 2 | |||||||||||
| 3 | |||||||||||
| 4 | 9/29/2025 | 99203-25 | Office Visit New L3 | 1 | $200.00 | none | $126.87 | $126.87 | |||
| 5 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | ||||
| 6 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 7 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 8 | 10/1/2025 | 98940 | CMT 1-2 Spinal Regions | 1 | $90.00 | none | $39.44 | $39.44 | |||
| 9 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | $20.14 | ||||
| 10 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | $44.47 | ||||
| 11 | 10/6/2025 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | |||
| 12 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 13 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 14 | 10/27/2025 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | |||
| 15 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 16 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 17 | 10/29/2025 | 99213-25 | Office Visit Est L3 | 1 | $120.00 | none | $85.01 | $85.01 | |||
| 18 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | ||||
| 19 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 20 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 21 | 11/26/2025 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | |||
| 22 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 23 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 24 | 1/26/2026 | 99213-25 | Office Visit Est L3 | 1 | $120.00 | none | $85.01 | $85.01 | |||
| 25 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | ||||
| 26 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 27 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 28 | 2/2/2026 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | |||
| 29 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 30 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 31 | 2/9/2026 | 98940 | CMT 1-2 Spinal Regions | 2 | $90.00 | none | $39.44 | $105.00 | |||
| 32 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | in the cap | ||||
| 33 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | in the cap | ||||
| 34 | 2/23/2026 | 98940 | CMT 1-2 Spinal Regions | 1 | $90.00 | none | $39.44 | $39.44 | |||
| 35 | G0283 | Electrical Stim Wound Care | 1 | $80.00 | none | $20.14 | $20.14 | ||||
| 36 | 97140-59 | Manual Therapy | 1 | $100.00 | none | $44.47 | $44.47 | ||||
| 37 | Subtotal, Ridgewood Spine and Rehabilitation | $3,140.00 | none | per unit | $1,344.99 | ||||||
| 38 | $3,140.0033 lines | none0 paid | per unitnot summed | $1,344.9910 dates | 8 days capped at $105.00 | ||||||
Every line is priced the same way and in the same order: the New Jersey PIP fee schedule for the code as billed, then the daily maximum applied to the date of service as a whole, and never more than what was actually billed. Two dates on this sheet carry the same three codes and differ by a single unit. 10/1 comes to $104.05 with every line priced on its own, and 10/6 comes to $105.00 with the day collapsed into one figure. Nothing on the sheet is estimated, and no line is deleted to make the arithmetic work.
| Rule | What it is | Citation |
|---|---|---|
| NJ PIP fee schedule | The maximum a carrier must reimburse for a given procedure under New Jersey no-fault. The figure is not one lookup: it moves with the CPT or HCPCS code and its modifiers, the provider's category, and which region of the state the service was rendered in. Getting any one of those wrong changes the dollars owed. | N.J.A.C. 11:3-29 |
| Daily maximum, physical medicine | New Jersey caps physical medicine and rehabilitation at $105.00 per patient per day, across every provider billing that day. It is a ceiling on the day, not a rate for a code, which is why adding units cannot lift it. The cap does not reach examinations or imaging, which is why the office visits on this sheet are priced in full beside a capped day. | N.J.A.C. 11:3-29.4(m) |
| Usual, customary and reasonable | Where a procedure has no listed fee-schedule price, the UCR benchmark governs instead. No line on this sample falls to it: every code billed here is on the schedule. It is listed because the order matters, and the schedule is always asked first. | n/a |
| The carrier's explanation of benefits | What was actually paid, read off the carrier's own EOB and matched back to the bill by date of service and procedure code. That match is the step a manual reviewer most often gets wrong, because the EOB rarely lists the lines in the order the bill did. On this case every line came back at zero. | n/a |
The order is the point. The schedule is asked first, the daily maximum is applied to the day rather than to any line in it, and the usual and customary benchmark is reached for only when no scheduled price exists. A reviewer who applies them in a different order gets a different number.
| Document | Kind | Date of service | Lines that cite it |
|---|---|---|---|
| CMS-1500 p.1 | Bill | 9/29/2025 | 99203, 98940, G0283, 97140 |
| Exam note, 9/29 | Record | 9/29/2025 | 99203 |
| Daily note, 9/29 | Record | 9/29/2025 | 98940, G0283, 97140 |
| CMS-1500 p.2 | Bill | 10/1/2025 | 98940, G0283, 97140 |
| Daily note, 10/1 | Record | 10/1/2025 | 98940, G0283, 97140 |
| CMS-1500 p.3 | Bill | 10/6/2025 | 98940, G0283, 97140 |
| Daily note, 10/6 | Record | 10/6/2025 | 98940, G0283, 97140 |
| CMS-1500 p.4 | Bill | 10/27/2025 | 98940, G0283, 97140 |
| Daily note, 10/27 | Record | 10/27/2025 | 98940, G0283, 97140 |
| CMS-1500 p.5 | Bill | 10/29/2025 | 99213, 98940, G0283, 97140 |
| Exam note, 10/29 | Record | 10/29/2025 | 99213 |
| Daily note, 10/29 | Record | 10/29/2025 | 98940, G0283, 97140 |
| CMS-1500 p.6 | Bill | 11/26/2025 | 98940, G0283, 97140 |
| Daily note, 11/26 | Record | 11/26/2025 | 98940, G0283, 97140 |
| CMS-1500 p.7 | Bill | 1/26/2026 | 99213, 98940, G0283, 97140 |
| Exam note, 1/26 | Record | 1/26/2026 | 99213 |
| Daily note, 1/26 | Record | 1/26/2026 | 98940, G0283, 97140 |
| CMS-1500 p.8 | Bill | 2/2/2026 | 98940, G0283, 97140 |
| Daily note, 2/2 | Record | 2/2/2026 | 98940, G0283, 97140 |
| CMS-1500 p.9 | Bill | 2/9/2026 | 98940, G0283, 97140 |
| Daily note, 2/9 | Record | 2/9/2026 | 98940, G0283, 97140 |
| CMS-1500 p.10 | Bill | 2/23/2026 | 98940, G0283, 97140 |
| Daily note, 2/23 | Record | 2/23/2026 | 98940, G0283, 97140 |
23 documents behind 33 charge lines. Every figure on the review tab points at one of these, which is what makes the workbook usable as evidence rather than as a summary of it.
The charge exactly as the provider billed it. Date, code, description and units are read off the CMS-1500 and never edited. If the form says 98940 with two units, the sheet says 98940 with two units, whatever anyone thinks of it.
Four figures, each a statement of fact. What the provider charged, what the carrier paid, what the New Jersey PIP fee schedule allows for that code, and what is still outstanding once the daily maximum has been applied to the day. The outstanding column is the only computed one, and the rule that computes it is named on the line beside it.
The half of the sheet that survives a hearing. Every line names the rule that produced its figure and the two documents behind it: the bill page it was read off, and the treatment note that says the service happened.
The date on the bill, not the date the note was written. It prints once per day and the lines beneath it belong to that day. That grouping is not cosmetic: the daily maximum is applied per date of service, so the day is the unit the rule operates on.
The CPT or HCPCS code as billed, with the modifier beside it. Held as text on purpose, because G0283 is not a number. The modifier is not decoration here: -25 is what separates a billable examination from the treatment around it, and it is the reason the office visits on this sheet escape the daily cap.
The description as it appears on the claim form. It is carried through unedited so a reviewer can match the line against the note without translating anything.
Units as billed. This is the column that decides the day on this sheet. Two units of 98940 against one is the entire difference between the 10/1 visit, which is priced line by line, and the 10/6 visit, which collapses into a single capped figure.
The line charge as it appears on the claim, carried through unextended: a line billed at $90.00 with two units reads $90.00 here, because $90.00 is what the provider put on it. The fee-schedule column beside it is a per-unit rate and IS extended by units when the day is priced, so the two columns are deliberately not multiplied the same way. On this case the provider billed $3,140.00 and the schedule supports $1,344.99. The gap is not a discount and it is not a dispute. It is what the fee schedule says.
What the carrier has already paid on the line, read off its explanation of benefits. Every line on this case came back at zero, which is what makes it an arbitration rather than a shortfall argument.
The scheduled rate for that code, PER UNIT, before the daily maximum is applied. Two units of a $39.44 code contribute $78.88 to the day even though the billed column beside it still reads the single charge the provider wrote. It is a lookup against the code, its modifiers, the provider's category and the region, and it is the figure the other side will check first, which is why the column is labeled per unit in the totals row rather than summed into a number that would mean nothing.
What is still owed once the day has been run through the daily maximum. On a day under the cap it is the scheduled rate for that line. On a day over it, one line carries the whole day's $105.00 and the rest are shown as absorbed rather than deleted, so the arithmetic stays legible instead of leaving lines that appear to have been dropped.
The rule that produced the figure on that line, in the sheet's own words. It exists so somebody else can apply the same rule to the same facts and arrive at the same number, which is the only test a reconciliation has to pass.
The page of the billing packet the charge was read off. Each date of service on this case is its own CMS-1500, so the page number and the day move together.
The treatment note behind the charge. It answers the second question the carrier asks, which is not what the service costs but whether it happened.
The daily maximum reaches physical medicine and rehabilitation. It does not reach examinations or imaging, so an office visit billed with the -25 modifier on a treatment day is priced in full on top of the capped $105.00. That is why 9/29 comes to $231.87 and not $105.00, and getting it wrong in either direction is one of the more common manual errors on a PIP file.
The physical-medicine lines on this date come to more than $105.00 at the scheduled rates, so the whole day is capped at $105.00 under N.J.A.C. 11:3-29.4(m). The figure sits on the first line of the day and the remaining lines are marked as absorbed into it. The cap is a ceiling on the day across every provider billing it, not a rate for any one code, so adding units cannot lift it.
The line is real, it is priced on the schedule, and it is not separately payable because the day it falls on has already reached the $105.00 ceiling. Showing it rather than deleting it is deliberate: a reviewer checking the packet against the sheet has to be able to see that every billed line was accounted for.
What the carrier owes on this case: $1,344.99 against $3,140.00 billed and nothing paid. Every figure in it traces to a code on a bill page, a rate on the published schedule, and a rule applied in the open.
The provider name is invented and every date of service is shifted seven days from the workbook this was built from. The codes, the units, the charges and every fee-schedule figure are the workbook's own, unedited. The split is deliberate: the identity is the part that has to be fictional, and the arithmetic is the part that has to be checkable.
Eight of the ten dates of service on this case reach the $105.00 daily maximum and two do not, and the difference between them is a single unit on one line. That is the ordinary texture of a New Jersey PIP file rather than a constructed example, and it is why the reconciliation cannot be done by scanning a column.
The engine reads the packet, prices every line against the schedule, applies the daily maximum and names the document behind each figure. What is arbitrable, what to concede and what to file is the attorney's, and nothing leaves on the engine's say-so.
The reconciliation itself, one row per billed line, in date order. This is the sheet the demand is built on.
The rules that produced every figure on the review tab, with the citation for each. They are listed in the order they are applied.
Every bill page and treatment note the sheet cites, with the charge lines that cite each one. It is the reverse index: from a document to the figures that rest on it.
One provider, ten dates of service across five months. The carrier paid nothing on any of it. The bill type decides which schedule prices the line: this is a CMS-1500 professional claim, so the physician side of the New Jersey PIP fee schedule governs, not the facility side.
Opens the claim page the 99203 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 99203 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 99213 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 99213 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 99213 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 99213 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 98940 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 98940 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the G0283 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the G0283 charge. It answers whether the service happened, which is a separate question from what it was worth.
Opens the claim page the 97140 charge was read off. It is the document the other side checks first, because a figure nobody can point at is a figure nobody has to pay.
Opens the treatment note behind the 97140 charge. It answers whether the service happened, which is a separate question from what it was worth.
$17 per case.
That is the rate on the first fifty cases a month, and it steps down from there. The whole schedule is below rather than a number you have to ask us for.
| Cases filed in a month | Rate per case |
|---|---|
| The first 50 cases each month | $17 |
| Cases 51 through 100 | $9 |
| Every case beyond 100 | $4 |
You do not pay us for PLIGA, withdrawn, or lost cases. We are paid when you are paid.
From raw upload to a delivered Excel in six stages
PIP Engine processes a packet end to end without manual tagging, and all six stages usually finish inside two minutes on the 80 to 120 pages an average packet runs to. Each stage hands verified data to the next, and two page-accountability checkpoints reconcile page counts so a dropped page is flagged rather than silently lost.
Raw billing packet
Unsorted scans of bills, EOBs, AOBs, records
No manual tagging or pre-sorting
De-duplicate and OCR
Every page of every unique PDF is read
Many documents processed in parallel
Classify and separate
Dozens of document types identified
Two page-accountability checkpoints
Pull line items
Billed lines from the HCFA, paid lines from the EOB
Matched by date of service and CPT code
Apply the NJ fee schedule
Region, provider category, modifiers, caps
Amount outstanding computed per line
Audit-ready Excel
Workbook plus source pages, merged by type
Sent as secure, short-lived download links
What is PIP Engine?
PIP Engine is a HIPAA-compliant automation built for New Jersey no-fault (PIP) medical-bill review. It ingests unsorted scanned billing packets, reads every page, reconciles each billed service against the state fee schedule, and outputs an Excel workbook that documents the exact underpayment behind an arbitration demand.
PIP Engine runs unattended from end to end. An attorney or paralegal uploads a mixed set of scanned documents, and the pipeline sorts, classifies, extracts, and prices every billed line without any manual tagging. The workbook it produces is designed to be the evidentiary backbone of a no-fault arbitration demand. It is the first stage of a larger suite: its Excel output feeds a downstream brief generator that drafts the arbitration submission itself.
What problem does PIP Engine solve?
In New Jersey, auto insurance is no-fault: after a crash, your own Personal Injury Protection (PIP) coverage pays your accident-related medical bills regardless of who caused it. Insurers often underpay or deny those bills. PIP Engine proves the shortfall by reconciling every bill against the state fee schedule.
When an insurer underpays a PIP medical bill, the provider or the law firm representing them can take the dispute to New Jersey’s designated PIP dispute-resolution forum instead of filing a lawsuit. To win, they must document that the insurer paid less than the law requires. Today a paralegal does this by hand. They open scanned packets that mix many document types: medical bills (HCFA/CMS-1500 forms and UB-04 hospital bills), insurer Explanation of Benefits (EOB) statements, Assignment of Benefits (AOB) forms, ledgers, appeals, and medical records.
The packets often run to hundreds of pages, poorly scanned and out of order. For every service the reviewer reads the CPT code, the date of service, the amount billed, and the amount paid, then looks up the correct fee-schedule reimbursement and computes the shortfall. One mistyped code or wrong region lookup can sink a claim. It draws on the same disciplined extraction from scanned medical records that powers Desk across our regulated document work.
Why is applying the NJ fee schedule so hard by hand?
The reimbursement for a single procedure depends on several variables at once, and getting any one wrong changes the dollars owed. The New Jersey PIP medical fee schedule (N.J.A.C. 11:3-29) sets the maximum reimbursement per procedure, and that value shifts by region, provider type, procedure code, and modifier. All seven of its official exhibits are published in full on our free lookup, so the variables are easy to see for one code and still punishing across a packet.
Every lookup combines the CPT code and its modifiers, the provider’s category (individual doctor, ambulatory surgery center, or hospital), and the region of New Jersey (North or South). That is only the base lookup. A reviewer must then apply crosswalk substitutions when a code maps to another, bilateral pricing at 1.5x for the -50 modifier, a 50 percent reduction on the second identical same-day procedure (with certain add-on codes exempt), and per-date daily caps.
When a procedure has no listed fee-schedule price, the Usual, Customary and Reasonable (UCR) benchmark applies instead. PIP Engine encodes these rules directly, so pricing is consistent across every line and every packet. It runs inside the same single-tenant isolation and signed BAA chain that protects the rest of our regulated systems.
Who is PIP Engine for?
PIP Engine is for New Jersey personal-injury and no-fault law firms and the medical providers they represent in PIP arbitration. It targets the attorneys, paralegals, and billing staff who reconcile bills against the fee schedule by hand today, and the physicians, surgery centers, and hospitals whose underpaid claims those firms pursue.
The people who feel the most relief are the ones doing the mechanical grind today. A paralegal who spends hours keying CPT codes and cross-checking EOBs against bills gets that time back. A managing attorney gets a consistent, auditable reconciliation on every file instead of output that varies by whoever prepared it. PIP Engine removes the data-entry burden while leaving professional judgment where it belongs, with the attorney.
Is PIP Engine secure and HIPAA-compliant?
Yes. All OCR and AI processing runs on HIPAA-eligible AI infrastructure under signed Business Associate Agreements. Patient health information stays inside an isolated per-firm cloud boundary with its own encryption keys, and results are delivered as short-lived download links rather than raw email attachments.
Consumer AI endpoints, which carry no BAA, are never used, and no client data trains any third-party model. The systems are engineered to meet HIPAA standards and run on AWS and Google Cloud with single-tenant isolation, a signed BAA chain, encryption in transit and at rest, and audit trails. The pipeline never invents a fee-schedule value: any line with no fee-schedule match falls back to billed-minus-paid and is highlighted for attorney review rather than guessed. Read more about the security and HIPAA architecture behind every S2Reason system.
What do you get back?
You receive an audit-ready Excel workbook, delivered by email inside a secure ZIP. The workbook carries a line-by-line billing breakdown with fee-schedule value, amount paid, and amount outstanding per service, plus a case-summary and checklist sheet. Rows the engine cannot confidently price are highlighted for review.
The ZIP also contains the original pages re-organized into one merged PDF per document type, with all HCFAs together, all EOBs together, and so on, so a reviewer can verify any number against its source in seconds. Every figure traces back to a page the arbitrator can see. Firms that would rather their provider clients collect finished workbooks themselves than receive them by email run PIP Engine behind the Provider Portal, where each provider sees only its own cases. The pre-filing checks this reproduces, and the two documents that gate a case before any of it matters, are written up in how to file a NJ PIP arbitration demand on Forthright. To see PIP Engine against your own files, talk to the S2Reason team.
Built for one job: the NJ PIP fee schedule
PIP Engine is not generic medical billing. It encodes the region, provider-category, multiple-procedure, bilateral, daily-cap, and crosswalk rules that actually determine the dollars owed, and wraps its AI extraction in rule-based guardrails.
Whole-packet, zero-sort ingestion
Upload mixed, out-of-order scans. The engine sorts, classifies, and reconciles every page with no manual tagging or pre-organizing.
Built for the NJ fee schedule
It encodes North and South region resolution, provider-category tables, CPT crosswalks, bilateral pricing, the multiple-procedure reduction, and per-date caps.
Reads many carrier EOB layouts
It recognizes dozens of page types, including the major auto insurers' Explanation of Benefits formats, so it reads the paid amount correctly.
Total page accountability
Two enforced checkpoints reconcile every uploaded page against the delivered output, supporting evidentiary completeness in arbitration.
Deterministic guardrails around the AI
Modifiers, CPT codes, dates, and amounts are cleaned and validated by rule-based post-processors after each extraction step.
Resilient extraction
Extraction runs a primary model with automatic fallback to alternates, so a single provider outage does not fail the job.
The engine does the work that repeats.
You still make every call.
The mechanical work is automated and every figure is grounded in the document it came from, so any number can be checked against the page that produced it. The judgment a case turns on stays with your attorneys. Nothing gets filed on a machine’s say-so.
You keep the provider, the filing and the team you already have.
Bringing software into a practice usually costs it something: the client relationship, control of the work, or somebody’s job. This is built so that it costs you none of the three.
The provider keeps calling you
The practice that sends you the assignment still sends it to you. The relationship, the fee agreement and the file stay between you and them.
The demand is still yours
Your name is on the filing and every legal judgment behind it is yours. The engine prices each line and cites the document the price came from. It does not decide medical necessity, it does not decide causation, and it never signs anything.
Your team is still your team
Nobody gets replaced. The paralegals who prepare your packets today do the same work with the reconciliation taken off the front of it. Hiring, training and who does what stay your decisions.
The compliance questions your carrier and your provider ask, answered before they ask.
Your files stay in a dedicated, single-tenant environment. Every system runs on isolated infrastructure under a signed BAA chain.
Your own cloud account: A single-tenant environment on AWS or Google Cloud, controlled by your firm and used by nobody else.
Under a signed BAA chain: Every environment runs under a signed Business Associate Agreement, with every figure traceable to the document it came from.
Your data stays yours: No third-party exposure and no external model training on your packets.
HIPAA
Your packets stay inside a dedicated, single-tenant environment, processed under a signed BAA chain and encrypted in transit and at rest.
Dedicated Environment
Your system runs in its own cloud environment on AWS or Google Cloud, isolated from every other firm. Your files are never downloaded to our own machines, and they are never sent to a public API.
NJ PIP reconciliation, answered
What is NJ PIP and why do these bills end up in arbitration?
New Jersey is a no-fault auto-insurance state: your own Personal Injury Protection (PIP) coverage pays your accident-related medical bills regardless of fault. Insurers often underpay or deny those bills. Providers dispute the shortfall through PIP arbitration rather than a lawsuit, and to win they must document the exact underpayment against the state fee schedule.
What does PIP Engine actually do?
PIP Engine converts a firm's raw, unsorted PDF packet of bills, EOBs, and forms into an audit-ready Excel showing how much each provider is still owed. It reads every page with no manual data entry, classifies and separates the documents, extracts each billed line item, and applies the NJ PIP fee schedule to compute the shortfall.
What exactly does PIP Engine produce for a Rule 16 arbitration summary?
Rule 16 of the New Jersey No-Fault PIP Arbitration Rules requires a summary of the claim describing every disputed medical service by date of service, type of service, amount billed and amount owed, the issue behind each disputed amount, and the evidence relevant to each one. The PIP Engine workbook carries all three: a row per billed line with the date, the service, what was billed and what is still owed under the fee schedule; the pricing rule that produced each figure, such as the $105 daily maximum on physical medicine; and the claim page and treatment note behind it. What it does not decide is the legal issues. Medical necessity and causation stay with the attorney, and the summary that gets filed is yours. Rule 16 is not itself a filing requirement: the summary is due with initial submissions, within 120 days of case initiation on the papers under Rule 53, or 20 days before an in-person hearing under Rule 39. The same workbook covers the requirement that does gate filing. Rule 7(11) requires the Demand for Arbitration to state the total claimed after crediting every payment received, and for services on the New Jersey Automobile Medical Fee Schedules it says plainly that no amount claimed shall be greater than the fee on the appropriate schedule. That is the same arithmetic, needed earlier, and overstating it puts the wrong number on the face of the demand.
Does a human still need to review the output?
Yes, by design. The engine flags anything it cannot confidently price, and any AI-assisted legal content is explicitly marked as needing attorney review. PIP Engine removes the mechanical grind of reconciliation, not the professional judgment that belongs to the attorney.
How does it handle EOBs from different insurance carriers?
PIP Engine recognizes dozens of distinct page types, including the major auto insurers' Explanation of Benefits layouts, so it reads the paid amount correctly across carriers. It then matches each paid line back to the original bill by date of service and procedure code, which is the step manual reviewers most often get wrong.
Why is applying the NJ fee schedule so hard to do by hand?
Because the reimbursement for one procedure depends on the CPT code, its modifiers, the provider category, and the region of New Jersey, all at once. On top of that base lookup, a reviewer applies crosswalk substitutions, bilateral pricing at 1.5x for the -50 modifier, a 50 percent reduction on the second identical same-day procedure with add-on exemptions, and per-day caps. Only then can they subtract what the insurer paid. One wrong variable changes the dollars owed.
Is patient health information kept secure and HIPAA-compliant?
Yes. All OCR and AI processing in PIP Engine runs on HIPAA-eligible AI infrastructure under signed Business Associate Agreements. Data stays inside an isolated per-firm cloud boundary with its own encryption keys, and results are delivered through secure, short-lived download links rather than raw attachments. A signed BAA for your firm is available on request at support@s2reason.com.
How long does PIP Engine take on one packet?
Usually under two minutes. An average New Jersey PIP packet runs 80 to 120 pages, and all six stages, reading every page, classifying the documents, extracting the line items and applying the fee schedule, complete inside that window. That is the engine's clock, not the firm's: a reviewer still checks the rows the engine flagged as unpriceable, and that judgment stays with the attorney. The first packet is free, so the two-minute figure can be timed on a real file before anything is paid.
What does PIP Engine cost?
$17 per case for the first fifty cases in a month, $9 for cases 51 through 100, and $4 for every case beyond that. Each band prices only the cases inside it, the way tax brackets do, so a month with 100 cases comes to $1,300 and a month with 200 comes to $1,700. Nothing is charged for PLIGA cases, and a case that is withdrawn or lost in arbitration is reimbursed. S2Reason is paid when the firm is paid, on a settlement or an award.
How does a firm start with PIP Engine?
Bring one real packet, the kind a paralegal would otherwise reconcile by hand. We run it through PIP Engine and show you the Excel output before you commit to anything. To arrange that, email support@s2reason.com with the approximate page count of the packet.