Regional Health Plan Discovers 28% More Codes, Capturing an Additional $4.8M in Revenue with RAAPID
By strengthening evidence-to-code alignment, a large regional Medicare Advantage health plan captured 28% more net-new defensible codes and unlocked $4.8 million in incremental Medicare Advantage revenue.
Missed billable codes, compliance vulnerabilities, inefficient manual workflows, and an outdated interface reduced revenue capture and slowed coder productivity.
Solution Overview
Clinical AI and Document AI review claims and clinical documentation to uncover every relevant code supported by audit-ready evidence, enabling coders to prioritize validation through a seamless, intuitive interface.
Key Outcomes
- 28% more net-new codes vs. incumbent platform
- $141,000 additional revenue in 735-member pilot
- $4.8M projected revenue for 25,000 MA members
- Evidence-based coding with audit-ready clinical documentation
Client Testimonial
“RAAPID captures clinically accurate conditions in real time and anchors each code to documented evidence, delivering audit-defensible results our previous system could not.”
— Risk Adjustment Leader, Regional Health Plan