Health Data Max is a technology startup that revolutionizes risk adjustment for Medicare Advantage payers and risk-bearing providers/ACOs through its AI-enabled SaaS platform, Audit360. This platform uses advanced natural language processing (NLP) to enhance the accuracy of clinical coding and risk adjustment data, ensuring compliance and precision throughout the claim lifecycle—from patient visits to CMS submissions. By leveraging custom large language models (LLMs), Audit360 extracts diagnoses and evidence from encounter data, identifies linked and unlinked submissions, and provides an intuitive workflow to improve risk adjustment data.

Audit360’s secure web-based platform offers advanced features such as optimal chart identification, insufficient documentation flagging, corrective action tracking, and custom chart queues. These features enable payers to drive better outcomes and mitigate audit risks effectively. Health Data Max’s solutions help stakeholders stay ahead in the evolving landscape of Medicare Advantage risk adjustment by providing transformative tools that ensure accuracy and compliance at every step.

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