Leading Multi-State Provider-Owned Payer Unlocks $4K Per Member Revenue
By deploying EHR-agnostic AI across fragmented data sources, this Health plan overcame data silos and manual review bottlenecks, enabling defensible coding with audit-ready evidence across its entire network.
Manual chart reviews, overwhelming data volume, provider fatigue, and missed conditions led to over $1 million in lost CMS reimbursements.
Solution Overview
RAAPID deployed EHR-agnostic AI to analyze charts, claims, and lab reports across fragmented data sources. The platform surfaced missed conditions with linked clinical evidence, enabling coders to validate findings faster while ensuring audit readiness.
Key Outcomes
- 60% faster chart reviews with enhanced care delivery
- 25% coding accuracy improvement via better condition identification
- $4,000+ potential revenue per member recaptured
- Audit-ready submissions backed by documented clinical evidence
Client Testimonial
“RAAPID solution has transformed our pre-visit chart review process, adeptly recapturing and suspecting various care gaps, increasing compliant ROI by mitigating audit risks. Every code is backed by clinical evidence, documented accurately and in a timely manner, giving us confidence that our submissions will withstand any audit scrutiny. Its profound impact on our overall operations has set a new standard for excellence in patient care management.”
— CEO, Multi-State Provider-Owned Payer