Risk Adjustment Coding Technology & Services for Health Plans
Ensure an efficient and compliant RAF score analysis
Detailed Retrospective HCC Risk Adjustment for Health Plans
Hierarchical Condition Category (HCC) code and RAF score review and audit are essential components of risk adjustment coding solutions for health plans. The HCC codes form the basis for calculating a patient’s Risk Adjustment Factor (RAF), which determines the reimbursement amount that a health plan receives from Centers for Medicare & Medicaid Services (CMS).
A thorough HCC code review ensures that all conditions associated with a patient are accurately documented by providers and appropriately coded to reflect the level of severity. This process is critical in capturing chronic diseases such as diabetes, hypertension, and heart failure, among others.
An HCC audit serves as an evaluation tool to ensure compliance with industry standards and identify areas for improvement in documentation practices. It also helps prevent any possible errors or omissions that could result in potential revenue loss. In addition, an effective HCC code review and audit process can lead to improved accuracy in RAF calculations and ultimately better financial outcomes for health plans.
We Support Health Plans Including
Medicare Advantage Organizations (MAO’s)
Commercial ACA (Affordable Care Act) Plans
State Medicaid
Programs
Our Risk Adjustment Technologies
HCC CAPTURE
Chart review solution for health plans
A comprehensive chart review solution to help health plans comply with HCC coding requirements and accurate RAF scores.
HCC COMPASS
Chart audit & claim comparison solution for a health plans
A powerful medical chart auditing and claim comparison solution to provide transparency in complex healthcare coding and billing.
Solutions for Value-Based Care
Unified platform for your end-to-end value-based care journey.
Each stands alone—and gets better together.
Prospective Risk Adjustment
Comprehensive care continuum optimization from pre-visit planning through post-visit HCC coding validation.
✓ Prioritize high-risk patients
✓ Proactive HCC gap closure
✓Reduce provider abrasion
✓ EHR integrated solution
Retrospective Risk Adjustment
Autonomous platform to stratify high-risk patients, chart review, HCC identification, and MEAT validation workflow.
✓ Reducing project timeline from months to days
✓ Evidence-based audit trail with justification
✓ Reducing program cost by over 40%
RADV Audit Solution
Run MEAT evidence-first checks, generate export files, and manage responses with clear audit trails for extrapolation protection.
✓ RADV-compliant workflow
✓ Expert auditor oversight
✓ Future-proof audit defense
AI as a Service (AIaaS)
Neuro-Symbolic AI that integrates with existing systems and workflows.
✓ API integration
✓ Custom workflows
✓ Scalable deployment
Results That Transform Your Performance
Financial Impact
Revenue & RAF uplift
$2500+Per member Appropriate Revenue Gain
10:1Guaranteed ROI
Delivered
Clinical Outcome
Proactive care reduces
hospitalization/ER visits
Weekly hours saved by clinicians
in documentation
Reduction in chart review time
Compliance
Accuracy with audit-ready documentation support
100%Evidence-backed code
justification
Why RAAPID’s Risk Adjustment Technology Solutions and Services for Health Plans
Our NLP technology into chart review and claim comparison processes provides faster analysis with higher accuracy rates at lower costs compared to traditional methods.
A knowledge graph in NLP-powered chart review and audits is that it allows health plans with a rapid identification of potential errors or omissions in documentation.
Quickly extract important information from insurance claim forms, making it easier to identify potentially fraudulent claims or errors before they are processed.
Improve the accuracy, efficiency, and consistency of chart reviews by automatically identifying potential errors, discrepancies, or anomalies.
Through our clinical APIs confidently share critical information across disparate systems leading and improve efficiencies across workflows.
How Do We Support You
What Our Customers Say
Talk to Our Customers
Have a candid conversation with a risk adjustment leaders who broke free from the vicious cycle of time consuming reviews, missed revenue, and vendor chaos.
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