Natural Language Processing (NLP) capabilities to analyze and interpret clinical documentation, including unstructured data such as progress notes, discharge summaries, and other clinical reports.

1. Advanced coding algorithms and models that can automatically identify missed or undocumented diagnoses, as well as potential coding errors.

2. Integration with electronic health records (EHRs) and other healthcare information systems to access relevant patient data and streamline coding workflows.

3. Automated workflows and tools that help coders prioritize their workloads, identify high-risk patients, and reduce manual errors.

4. Customizable reporting and analytics capabilities that enable users to track coding accuracy and productivity, monitor coding trends over time, and identify areas for improvement.

5. Compliance features that ensure coding practices align with Medicare Advantage regulations and guidelines, as well as with the organization's own coding policies and standards.

6. Secure data exchange and storage features that meet HIPAA compliance standards and ensure data privacy and security.

PROSPECTIVE RISK ADJUSTMENT

ENSURE HCC REPORTING ACCURACY

Enabling clinical AI rules based HCC analytics on the claims data can provide valuable insights into your Medicare members’ prospective RAF score and help focus on chronic conditions that need timely attention and help improve quality of care

RADV Audit READINESS

RESOLUTION & CORRECTION

With our advanced analytics, you can protect your RAF score revenue by audit-proofing your Risk Adjustment Data Validation process so that you can successfully pass through RADV audits when they arrive

RAF SCORE ANALYTICS

TOTAL FINANCIAL IMPACT

View accurate financial impact at the member level or at the provider level thus quantifying expected Risk revenue loss or increments over defined period