Cases don't start clean. A member uploads whatever they have — crumpled statements, a photo of an EOB, a collections letter — through the member portal, or a case opened in Salesforce or Zendesk starts it automatically. Either way, the moment it lands the job becomes a durable task: months of waiting, replies, and deadlines will hang off this one thread.
Work out what's actually owed on Maria G.'s hospital bills — and get the overcharges back.
Grain reads the whole shoebox before it forms an opinion. Documents are classified by what they are, not what they're named; bills are lined up against insurance explanations and bank receipts; every charge code is audited; and a deadline clock starts on the appeal window and the charity-care application. The deciding question in most cases — was the repriced bill ever actually paid? — is answered against the payment record, not the provider's portal.
Everything worth knowing is pulled out and organized, each fact with a pointer back to its page. Then the checks run, in plain terms: what holds up sits next to what doesn't. Here, the provider's portal contradicts the bank — the bill was paid on March 14 and still shows as open.
- Patient
- Maria G. · account #48-2214
- Total billed
- $18,412 across 3 statements
- Insurance paid
- $9,180 — cleared Mar 14
- Maria has paid
- $2,340 to date
- In collections
- $4,912 · one letter, dated May 2
- The insurance payment really cleared — the bank receipt matches the EOB
- The ER visit was billed to the right plan
- The collection letter's amount matches the provider's own ledger
- The provider's portal still shows the paid bill as unpaid
- Two charges appear twice on the March statement
- One lab charge doesn't appear anywhere in the medical record
What comes out is a packet, not a chat answer. On top sit the documents the work produced: the case assessment, a follow-up plan with dates, a plain-language update for Maria, and every proposed send — fax to the billing office, email to the payer — as a checkable action. Underneath, the proof layer: a validation pass that lists anything wrong with the actions themselves (a missing contact, placeholder text, a bad page reference), an independent claim-by-claim verification with citations, and one reviewable page that ties it all together.
Rosa works the case by talking to Nia — the assistant on every Grain task. Nia walks her through the violations list and the verifier's report; Rosa can approve the sends, ask Nia to rewrite a letter, or hand her a corrected EOB and have the affected work re-run from the last checkpoint, not from zero. When Rosa approves, her own systems execute the sends — Nia prepares the actions but never fires them herself.
Maria is owed $2,340 — and qualifies for the hospital's charity-care program.