In a landscape where Medicare Advantage (MA) plans face increasing regulatory scrutiny and mounting pressure to optimize coding accuracy, Health Data Max delivers a game-changing solution: Audit360™, a secure, AI-powered platform purpose-built for payers, ACOs, and risk-bearing providers.

Unlike legacy tools that only address fragmented parts of the risk adjustment cycle, Audit360 offers end-to-end capabilities spanning prospective, concurrent, and retrospective risk adjustment workflows. From surfacing suspected HCCs based on care gaps and historical utilization to validating documentation pre- and post-submission, Audit360 ensures your organization stays ahead—compliantly and profitably.

Built for Accuracy. Designed for Action.

At the core of Audit360 is our proprietary natural language processing (NLP) and custom-trained large language models (LLMs) that extract diagnoses, clinical evidence, and condition relationships from encounter data—regardless of source or structure. Whether processing structured claims or parsing provider notes, Audit360 detects coding inconsistencies, flags unsubstantiated conditions, and surfaces missed opportunities for risk capture.

What sets Audit360 apart?

Suspecting & Prospective HCC Identification: Pinpoint members likely to have undocumented chronic conditions using AI-powered algorithms trained on historical patterns, utilization, and clinical similarity.

• Retrospective Chart Review & Validation: Easily link or delink diagnoses based on audit-readiness criteria, ensuring CMS-compliant documentation and closing coding gaps.

• Intelligent Chart Selection: Prioritize high-value charts with potential revenue or compliance impact through customizable queue logic.

• Compliance & Audit Preparedness: Track insufficient documentation, monitor corrective actions, and maintain a defensible audit trail for RADV or external reviews.

• Real-time Coding Support: Provide in-workflow AI suggestions and coding validation to improve accuracy before submissions go to CMS

All-in-One Platform. No Gaps Left Behind.

Audit360’s web-based interface is purpose-built for medical coders, audit teams, and clinical review staff. With role-based access, configurable dashboards, and seamless integrations, your team can focus on driving risk adjustment performance—not managing spreadsheets or siloed systems.

Whether you're aiming to:

• Defend against RADV audits

• Enhance RAF score accuracy

• Identify high-risk, high-impact conditions

• Eliminate data leakage and coding errors

...Audit360 gives you the visibility, automation, and confidence to act decisively.

DATA CONSOLIDATION

ROBUST DATA MANAGEMENT

Extract, transform, and consolidate encounter data for submission to CMS, paired with operational reporting

CLAIMS TRANSACTIONS

STREAMLINED CLAIM TRANSACTIONS

Generate and submit clean claims transactions required for all encounter types (X12 5010 837 I, P, and DME)

CMS RESPONSES

DETAILED AND ACTIONABLE

Load and process CMS responses to claims transactions (TA1, 999, 277CA, MA-002, MA-004, MORs and others)

ERROR MANAGEMENT

RESOLUTION & CORRECTION

Get access to highly configurable and robust error queue management

ADVANCED HCC ANALYTICS

MACHINE LEARNING DRIVEN ANALYTICS

Clinical AI-based HCC rules engine to give more predictability into your HCC recapture and provides robust leverage to your prospective and concurrent Risk adjustment processes

ENCOUNTER SUPPORT

FULL-RANGE OF SUPPORT TOOLS

Support all variations of encounters including: standard, capitated, void and adjusted, chart linked and unlinked, and deleted, as well as encounters from atypical providers