Claude Prompt: Medical Lien and Subrogation Audit with Reduction Request Letter
Audits every lien and reimbursement claim on a settlement (Medicare, Medicaid, ERISA or other health plan, provider liens, med-pay), isolates unrelated charges and arithmetic errors, then drafts the reduction request. It never says a doctrine applies without the governing text.
The Prompt
Variables (8)
| Variable | Description | Example |
|---|---|---|
| {{client_name}} | Client Name | Maria Gonzalez |
| {{gross_settlement_amount}} | Gross Settlement Amount (USD) | 250000 |
| {{attorney_fee_and_costs}} | Attorney Fee and Case Costs | Fee $83,333.33 (one-third of gross per fee agreement); case costs $6,412.80 |
| {{lienholder_for_letter}} | Lienholder for Reduction Letter | Summit Health Plan, Subrogation Unit, file no. SR-2026-88140 |
| {{incident_summary}} | Incident Date and Injury Summary | Rear-end collision on 03/14/2026. Injuries: C5-C6 disc herniation, left shoulder labral tear. Pre-existing: type 2 diabetes, 2019 right knee arthroscopy. |
| {{lien_claims}} | Lien Notices and Payment Ledgers | Each lien notice or conditional payment letter and the itemized payment ledger: date of service, provider, code or description, amount billed, amount paid. |
| {{plan_or_statute_text}} | Plan or Statutory Language for Each Lien | The reimbursement and subrogation section of the plan document (not only the summary), the lien statute text relied on by the hospital, the med-pay reimbursement clause. |
| {{reduction_law}} | Governing Law on Lien Reduction | Text of the statutes, regulations or case passages in your jurisdiction on procurement-cost sharing, made-whole and common-fund, with citations. |
Expected Output
An analysis block; Part 1, attorney-only notes (lien inventory table, per-claim audit with the asserted basis, line-by-line arithmetic, duplicates, apparently unrelated charges and reduction arguments marked supported or needing authority, net-to-client table as claimed and as proposed, conflicts between sources, unsupported statements declined, declined requests, Missing information); Part 2, a clean reduction request letter to the named lienholder; and a closing Verification list.
Usage Notes
Use once a settlement figure is known and before any lien is paid. Attach every lien notice with its itemized ledger, the actual plan document or statute text behind each claim, and the law of your jurisdiction on reductions. Part 1 is for the file; only Part 2 is meant to leave the office. Failure mode to watch for: a reduction argument presented as available when the plan language or governing law forecloses it, a charge called unrelated without a record basis, or an amount proposed against a statement that is still interim; rows marked as needing authority are research tasks, not arguments ready to send, and any case the lienholder cites must be pulled and read. Read the document part line by line before it leaves the office: in testing, a small model sometimes left an internal remark, a comparison with the file or an unresolved point inside the document despite the instructions. Not legal advice. The attorney remains responsible for verifying every fact, figure and authority before use.
Double-check before use
- Check that the letter sets no response period you did not supply and opens with no bracketed note.
- Check that every charge flagged as a duplicate is removed from the proposed amount.
These are the places where this prompt was seen to slip when tested on sample cases with a small AI model.
Legal Sources Referenced
- 42 U.S.C. § 1395y(b)(2)(B) (Medicare conditional payments are conditioned on reimbursement to the Trust Fund by a primary plan and by an entity that receives payment from it)
- 42 C.F.R. § 411.37 (Medicare reduces its recovery to take account of the cost of procuring the judgment or settlement)
- US Airways, Inc. v. McCutchen, No. 11-1285 (U.S. Apr. 16, 2013) (in a § 502(a)(3) action based on an equitable lien by agreement, the ERISA plan's terms govern; the common-fund doctrine is the default rule where the plan is silent on attorney's fees)
- Arkansas Department of Health and Human Services v. Ahlborn, No. 04-1506 (U.S. May 1, 2006) (federal Medicaid law does not authorize a state lien on a settlement beyond the portion representing medical expenses)
Originally featured in: AI for Personal Injury Lawyers: Prompts for Demand Letters, Medical Summaries & Depositions
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* These prompts are drafting and analysis aids for licensed attorneys. They are not legal advice and do not replace professional judgment. AI output can contain errors, including invented citations and incorrect deadlines: verify every fact, figure, authority and deadline against primary sources before relying on it. Rules vary by jurisdiction, and you remain responsible for the final work product.