Prospective Risk Adjustment

Surface Emerging Suspects No Chart or Claim Shows Yet

RAAPID reads clinical indicators in claims, labs, and charts to flag emerging suspects so physicians can act.

Prospective LP a 4

EHR Integration

Works with any EHR. Connect through FHIR, HL7, or a simple file transfer.

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What Sets RAAPID Apart: Emerging Suspects

From a Flag in the Chart to Action at the Visit

RAAPID connects labs, symptoms, and medications across the chart to flag conditions never documented or claimed.

Illustrative

Before the visit · RAAPID

Step 1

In the record

Hypertension, two eGFR results below 60, no kidney diagnosis.

Step 2

RAAPID flags

Suspected CKD stage 3, linked to both labs.

Illustrative

At the visit · Physician acts

Step 3

At the visit

The physician walks the patient through the lab trend and asks about swelling, fatigue, or changes in urination.
Step 4

Next step

The physician orders a repeat eGFR and urine albumin test, then documents CKD if confirmed or rules it out.
Why Prospective Programs Stall

The Condition Is in the Chart. The Physician Never Sees It.

No Time to Dig Before the Visit

Physicians can't scan years of labs, notes, and medications for every patient. Conditions hiding in the data go unaddressed.

Every January, the Slate Resets

Chronic conditions must be documented again each year. The ones not revisited quietly drop off, and so does the accuracy of your risk scores.

Lists Without Evidence

Lists arrive from every health plan and EHR prompt, most without evidence. Physicians need one list they can act on, with the proof attached.

RAAPID brings one reviewed list to each visit, with the evidence behind every suspect.

Member Targeting and Pre-Visit+

Prepare Every Visit Before the Patient Arrives

Charts, claims, labs, and pharmacy data come in; your reviewers curate what reaches each physician.

Charts pulled only where findings are likely

Each condition shown once, hierarchies applied

Review rules and coding guidelines set per program

Batched to each physician's schedule, curated first

Illustrative

Tuesday schedule, reviewed

Ready

9:00
Patient A
Annual wellness visit

1 suspect

2 gaps

9:30
Patient B
Follow-up

1 gap

10:15
Patient C
Chronic care visit

1 suspect

1 add

11:00
Patient D
New patient

No findings

Point of Care

Give Physicians Answers Inside the EHR

Findings appear in the workflow physicians already use, with one click to the evidence behind each.

Accept and document, or reject with a reason

Anything not addressed carries to the next visit

Nothing coded without a face-to-face visit, per RADV

Rejection reasons improve each physician's list

Illustrative

Pre-visit findings

In your EHR

Suspected COPD

True suspect

View evidence: inhaler fills, 2 progress notes
Accept and document
Reject with reason
Type 2 diabetes with complications

Historical

View evidence: documented last year
Accept and document
Reject with reason
Post-Visit and Reporting

Close the Loop Before Claims Go Out

RAAPID checks the finalized chart against the claim and the physician’s decisions, before the claim goes out.

Unclaimed and unsupported codes flagged

Missing MEAT routed to CDI

Accepted at the visit but never documented, caught

Acceptance, rejections, and RAF accuracy by physician

Encounter reconciliation

Before submission

Captured
Accepted at the visit and documented

Ready

Missed
Accepted at the visit, not documented

Review

Unclaimed
Documented, missing from the claim

Add

Over-claimed
On the claim, no chart support

Remove

Missing MEAT
Monitoring or treatment evidence absent

To CDI

WHAT OUR CUSTOMERS SAY

"

RAAPID gave our organization a clear view of code gaps across our entire population, including conditions no one had documented before. Our physicians now go into each visit with a reviewed list of suspects and the chart evidence behind each one, and nothing is coded unless they confirm it. Closing code gaps is now part of the visit, not a year-end chase.

VP, Provider-Owned Health Plan

Explore the Latest From RAAPID

PH Case Study v7 Generalize version
Case Study

~90K Suspects Across 257K Members in Under Two Weeks

How a regional provider-owned health plan surfaced evidence-linked suspects from ~40M chart pages.
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Webinar

V28 Beyond the 2026 Transition: What Does It Means for Your Risk Adjustment Program?

V28 is fully live and locked in through 2027. Wynda Clayton explains what it means for your program.
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Guide

The Essential Guide to CMS-HCC Model V28

Access the full list of chronic conditions and key updates.

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Blog

How to Resolve HCC Gaps: Best Practices for Healthcare Providers

Strategies to close HCC gaps, keep coding accurate, and protect reimbursement.

Frequently Asked Questions 

Code gaps, unclaimed conditions, unsupported codes, and emerging suspects. You choose what reaches physicians.

A chronic condition never documented or claimed, inferred from labs, symptoms, and medications. Only the physician can confirm it.

No. Start with the step you’re missing and add the rest later.

Charts, claims, labs, pharmacy, and radiology from the last two years plus the current year, via EHR integration or file transfer.

Under two weeks for 257K members at one health plan.

Your pre-care nurses or coders, or RAAPID’s experienced coders. Your choice. Physicians only see the validated list.

Start with one practice of employed providers. Watch the acceptance dashboard, then extend to independent groups with your own adoption data in hand.

See What Your Next Visits Could Look Like

A walkthrough on sample charts, set up your way.

Members reviewed
0 K
Chart pages
0 M
Members with suspect conditions
0 K
Missed HCCs/RxHCCs
~ 0 K
~$ 0 M

Potential value

Results from one regional provider-owned health plan, in under two weeks. Potential revenue at 50% provider confirmation.

Prospective Risk Adjustment Solution Page

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