A Top-Tier Multi-State Health Plan Generates $3M at 98.5% Accuracy
A multi-state Medicare Advantage plan transformed risk adjustment operations with AI-powered chart review, generating $3 million in additional revenue while ensuring audit-ready compliance through defensible coding.
Missed revenue from undercoding, compliance risks from overcoding, looming submission deadlines, and costly multi-vendor management threatened reimbursement optimization.
Solution Overview
AI-powered first and second-pass chart reviews deliver accurate HCC coding with human-in-the-loop validation. Customizable workflows ensure defensible submissions, reduce audit penalty risk, and accelerate turnaround without sacrificing compliance.
Key Outcomes
- 98.5% accuracy across all submitted codes
- $2,976,000 additional revenue from 992 new HCCs
- 100% of charts reviewed in under 2 weeks
- Every code supported by clinical evidence for audit defense
Client Testimonial
“We are impressed with RAAPID’s findings and ability to customize as per our guidelines with a quick turnaround time. What sets them apart is defensible coding. Every HCC is documented with clinical proof, captured accurately when it happens, so we never worry about audits. Our coders also liked the SaaS platform and were able to do the final review of the remaining charts. We are planning to start the next project soon.”
— Director, Operations, Multi-State Health Plan