Health Data Max
Powered by Agentic AI, Health Data Max connects every function—analytics, documentation, validation, and audit—through one autonomous, governed system
From identifying missed HCCs to validating encounters before submission, AgentHDM agents turn fragmented workflows into a single, intelligent operating layer — reducing rework, improving accuracy, and strengthening compliance.
Each AgentHDM agent is engineered as a purpose-specific decision system — not a generic AI assistant. While agents share a common intelligence layer, their capabilities are tightly scoped to the function they perform, ensuring consistent behavior across analytics, chart review, and submission workflows.
Agents combine deterministic logic (CMS guidance, HCC hierarchies, and submission rules) with statistical models trained on historical claims, encounters, and chart data. This hybrid approach allows the system to produce explainable outputs — showing what was identified, how it was evaluated, and which evidence supports the result.
Rather than acting autonomously on source systems, agents generate structured, traceable outputs designed for downstream use by analysts, coders, and operations teams — enabling review, validation, and confident execution at scale.
VALIDATING SUBMISSIONS AGAINST YOUR CLAIMS AND EHR MEDICAL RECORDS
PROVEN ENCOUNTER SUBMISSIONS ENGINE
FINANCIAL RECONCILIATION TO MINIMIZE RISK AND MAXIMIZE REVENUE
BUILD YOUR OWN CUSTOM-TRAINED LARGE LANGUAGE MODEL ON YOUR DATA
PREDICTIVE RISK ADJUSTMENT ENGINE
CLOSE PREDICTED GAPS AT POINT OF CARE THROUGH EHR-INTEGRATED PHYSICIAN WORKFLOW
3-Pillar Value Proposition
1. Chart AI Copilot
Delivering real-time clinical intelligence at the chart level
Leverages proprietary NLP and LLMs to scan structured & unstructured data for HCCs and missed coding opportunities.
Assists coders and QA teams with compliant code suggestions, source-linked references, and confidence scoring.
Supports prospective, retrospective, and concurrent chart reviews.
Tracks every action for audit-readiness and traceability (full audit trail).
Seamlessly integrates with your existing EHR or coding platform.
2. CMS Submission Compliance
Automated validation and reconciliation across your entire submission pipeline
Ingests and analyses X12 837 I/P/D encounter files.
Monitors TA1, 999, 277CA, MAO-002, MAO-004, MMR, and MOR files for errors and rejection trends.
Real-time dashboards flag rejected or dropped encounters.
Built-in reconciliation tools link rejected claims to charts, ensuring no revenue is lost.
Keeps your plan audit-ready and aligned with CMS requirements.
3. RAF Optimization
Drive more accurate risk scoring and maximize revenue without over-coding
Identifies undocumented HCCs across clinical records using AI.
Prioritizes high-impact, high-chronic patients to close the right gaps first.
Supports prospective programs that improve performance before the look-back ends.
Reduces risk of over- or under-coding by flagging anomalies with contextual evidence.
Generates predictive RAF impact and submission completeness metrics.
Powered by Agentic AI & Fine-Tuned LLMs
Every Health Data Max solution leverage Agentic AI—a multi-agent intelligence architecture designed to continuously review CMS files, member charts, and claims data. Each product, from chart review to RADV defense, benefits from these agents’ ability to reason, validate, and adapt to changing CMS models.
This ensures unmatched accuracy, auditability, and compliance across your risk adjustment lifecycle.
FAQs
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We help payers and providers optimize risk adjustment accuracy, automate chart validation, and ensure CMS submission compliance using AI and NLP.
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Medicare Advantage plans, ACOs, and provider networks use our tools to capture accurate RAFs, reduce RADV risk, and improve revenue integrity.
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Request a demo or consultation to see how our platform integrates with your data systems and workflow.
Contact us