Autonomous, Agentic AI Solutions for the Entire Risk-Adjustment Lifecycle

Intelligent agents now collaborate across member targeting, chart retrieval, coding, submissions, and audits — closing gaps, ensuring compliance, and protecting revenue in real time.

prospective.PNG

360-DEGREE MEMBER DATA VIEW

VALIDATING SUBMISSIONS AGAINST YOUR CLAIMS AND EHR MEDICAL RECORDS

analytics.PNG

PROVEN ENCOUNTER SUBMISSIONS ENGINE

FINANCIAL RECONCILIATION TO MINIMIZE RISK AND MAXIMIZE REVENUE

ADVANCED CLINICAL-AI PLATFORM

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

  • We help payers and providers optimize risk adjustment accuracy, automate chart validation, and ensure CMS submission compliance using AI and NLP.

  • Medicare Advantage plans, ACOs, and provider networks use our tools to capture accurate RAFs, reduce RADV risk, and improve revenue integrity.

  • Request a demo or consultation to see how our platform integrates with your data systems and workflow.

We Love To Help. Reach Out Today!

Please complete the form below