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.

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360-DEGREE MEMBER DATA VIEW

VALIDATING SUBMISSIONS AGAINST YOUR CLAIMS AND EHR MEDICAL RECORDS

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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

Learn About latest CMS Medicare Advantage Rules

Exploring CMS’s 2026 Advance Notice: Key Updates for Medicare Advantage and Part D Programs

Summary

Medicare Advantage & Part D Updates

The 2026 Advance Notice outlines major shifts for Medicare Advantage and Part D:

  • Medicare Advantage: A 5.93% effective growth rate in capitation rates — the largest in nine years. CMS will also fully implement the 2024 CMS-HCC risk adjustment model and finalize phase-in adjustments for indirect medical education costs.

  • Part D: A new $2,100 annual out-of-pocket cap on prescription drug costs, with expanded manufacturer discounts in both the initial and catastrophic phases of coverage. Risk adjustment is being updated to align with the redesigned benefit design and cost-sharing structure.

  • Star Ratings: Introduction of a Kidney Health Evaluation measure for patients with diabetes, plus increased weighting for measures tied to maintaining or improving physical and mental health.

Broader Program & System Changes

Beyond payments and benefits, CMS is moving forward with systemic improvements:

  • PACE Program: Gradual transition to the updated CMS-HCC model, starting with a 10% blend in 2026 and reaching full adoption by 2029.

  • MARx System: Migration to a cloud-based infrastructure for improved scalability and security.

  • Normalization Factors: Updated to reflect trends from both pre- and post-COVID-19 periods.

These updates are designed to strengthen payment accuracy, audit readiness, and beneficiary protections, while driving higher-quality outcomes across Medicare Advantage, Part D, and PACE programs.

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Platform Impact

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