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# RAAPID INC: Risk Adjustment in Healthcare

## Sitemaps
[XML Sitemap](https://www.raapidinc.com/sitemap_index.xml): Includes all crawlable and indexable pages.

Healthcare AI company building defensible risk adjustment for Medicare Advantage plans, health systems, ACOs, and PACE organizations, using Neuro-Symbolic AI to validate every HCC against MEAT criteria with a traceable evidence trail.

RAAPID Inc. is a healthcare AI company building defensible risk adjustment for Medicare Advantage plans, health systems, ACOs, and PACE organizations. Its Clinical AI Platform uses Neuro-Symbolic AI — neural language understanding combined with symbolic reasoning over a clinical knowledge graph — to read unstructured medical records, validate every HCC against MEAT criteria, and produce a traceable evidence trail for each diagnosis. The platform supports two-way coding: adding supported diagnoses and removing unsupported ones, the pattern CMS and the OIG now expect. RAAPID reports 92% out-of-box coding accuracy, rising above 98% after human review. Headquartered in Louisville, Kentucky, with HITRUST r2 certification and investment from M12 (Microsoft's venture fund), UPMC Enterprises, and Healthworx (CareFirst).

## Core Solutions

- [Retrospective Risk Adjustment](https://www.raapidinc.com/retrospective-risk-adjustment/): AI chart review that finds HCC codes with evidence linkage and removes unsupported ones, in under 8 minutes per chart. Two-way coding built in.
- [RADV Audit Solution](https://www.raapidinc.com/radv-audit/): Purpose-built RADV audit readiness — defensible coding, mock audit workflows, and audit-ready evidence trails for Medicare Advantage plans.
- [OnePass Risk Adjustment Coding](https://www.raapidinc.com/onepass-risk-adjustment-coding/): Collapses multi-pass validation into a single evidence-backed review, eliminating redundant vendor queues and coordination overhead.
- [AI as a Service](https://www.raapidinc.com/ai-as-a-service/): APIs that add risk adjustment capability to existing systems without platform replacement or workflow change.
- [OnePass Challenge](https://www.raapidinc.com/lp/onepass-challenge/): Benchmark your current multi-pass coding results against a single OnePass review on your own charts.

## About RAAPID

- [About RAAPID Inc.](https://www.raapidinc.com/about-us/): Company overview, mission, and leadership.
- [Advisory Board](https://www.raapidinc.com/advisors/): Healthcare and technology executives advising RAAPID.
- [Kim Swafford](https://www.raapidinc.com/advisors/kim-swafford/): Industry Executive, Microsoft Healthcare.
- [Don Antonucci](https://www.raapidinc.com/advisors/don-antonucci/): President and CEO, Providence Health Plan; former SVP, Blue Shield of California.
- [Terry Shaw](https://www.raapidinc.com/advisors/terry-shaw/): Former President and CEO, AdventHealth.
- [Daniel Chaitow](https://www.raapidinc.com/advisors/daniel-chaitow/): Former Chief Business Development Officer, Innovaccer.
- [KLAS Emerging Company Spotlight](https://www.raapidinc.com/klas-emerging-company-spotlight/): May 2026 KLAS report on RAAPID's defensible coding and audit-ready retrospective risk adjustment.

## Reference Guides

Definitive explainers on risk adjustment mechanics, CMS rules, and compliance standards.

- [Risk Adjustment Coding: 2026 Guide to Defensible HCC Documentation and MEAT Criteria](https://www.raapidinc.com/blogs/risk-adjustment-coding/): How ICD-10-CM codes map to HCCs and build RAF scores, and why encounter linkage plus MEAT evidence now matters more than code volume.
- [CMS-HCC Model V28: What Changed, RAF Impact, and the CY2027 Update](https://www.raapidinc.com/blogs/cms-hcc-model-v28/): V28 became fully operative January 1, 2026, cutting valid ICD-10-CM codes from 9,797 to 7,770, expanding HCCs from 86 to 115, and lowering average MA risk scores by a projected 3.12 percent.
- [RADV Audits in 2026: What Medicare Advantage Plans Need to Know](https://www.raapidinc.com/blogs/radv-audits-2026/): Payment Year 2020 audits began February 2026 on a roughly quarterly cadence, with a restored five-month record window and samples of 35 to 200 enrollees.
- [RADV Audit Guidelines: 2026 Rules, MEAT Criteria, and Defensible Documentation](https://www.raapidinc.com/blogs/radv-audit-guidelines/): The CMS rules for confirming submitted diagnoses trace to a face-to-face payment-year encounter with documented active management.
- [RADV Audit Checklist: Complete Medical Record Guide for 2026](https://www.raapidinc.com/blogs/cms-radv-audit-checklist/): The pass/fail criteria CMS applies to each audited HCC — signature, legibility, valid provider type, payment-year date, and MEAT documentation.
- [CMS Risk Adjustment Submission Deadlines for 2026, 2027, and 2028](https://www.raapidinc.com/blogs/cms-risk-adjustment-submission-deadlines/): Initial deadline is the first Friday in September before the payment year; mid-year is the first Friday in March; final closes roughly 13 months after the payment year ends. After the final deadline CMS processes deletes only.
- [Simplify HCC Coding with MEAT Criteria](https://www.raapidinc.com/blogs/simplify-hcc-coding-with-meat-criteria/): How monitored, evaluated, assessed, and treated documentation supports each submitted diagnosis under CMS scrutiny.
- [The Defensible Risk Adjustment Playbook for 2026-27](https://www.raapidinc.com/blogs/defensible-risk-adjustment-playbook/): Five pillars of a defensible program — two-way validation, encounter linkage, evidence trails, mock audits, and provider enablement — against a 2026 enforcement backdrop.
- [Build Defensible RAF Scores: 2026 Strategy Guide](https://www.raapidinc.com/blogs/build-defensible-raf-scores/): Making every submitted diagnosis encounter-linked, MEAT-backed, and traceable from chart to claim.
- [CY2027 Rate Announcement: What It Costs Your Risk Scores](https://www.raapidinc.com/blogs/cy2027-rate-announcement-risk-score-impact/): CMS finalized CY2027 on April 6, 2026, with a net average payment increase of 2.48 percent, rising to roughly 4.98 percent including projected risk score trend.
- [CMS RxHCC Model and TrumpRx: What Risk Adjustment Teams Must Know for 2026](https://www.raapidinc.com/blogs/cms-rxhcc-model-trumprx-2026/): How Part D prescription drug risk adjustment and the TrumpRx policy changes affect risk adjustment operations in 2026.
- [The 2026 ICD-10-CM Update: 487 New Codes and What They Mean for MAOs](https://www.raapidinc.com/blogs/2026-icd-10-cm-updates-medicare-advantage/): Which of the 487 new and revised ICD-10-CM codes affect HCC mapping and Medicare Advantage documentation practice.
- [The CMS ACCESS Model and Medicare Advantage](https://www.raapidinc.com/blogs/cms-access-model-medicare-advantage-alternative/): What the CMS ACCESS Model introduces as an alternative pathway, and how it intersects with Medicare Advantage performance pressure.

## Coding Models and Workflow

- [Multiple Passes of Waste, OnePass of Defensible Coding](https://www.raapidinc.com/blogs/multi-pass-review-vs-onepass/): Why multi-pass review delivers shrinking accuracy returns while time and coordination costs keep climbing.
- [Retrospective Risk Adjustment: Two-Way Coding That Holds Up to Audit](https://www.raapidinc.com/blogs/retrospective-risk-adjustment/): Add-only chart review is now a documented compliance risk under 2026 OIG guidance and recent DOJ enforcement. What two-way coding replaces it with.
- [Prospective Risk Adjustment: Point-of-Care Decision Support](https://www.raapidinc.com/blogs/prospective-risk-adjustment/): Moving HCC documentation upstream to the encounter, now that CMS has finalized the exclusion of unlinked chart review diagnoses.
- [Concurrent Coding: Real-Time Risk Adjustment](https://www.raapidinc.com/blogs/concurrent-coding/): Coding during the encounter window, and why over 70 percent of patient data sitting in unstructured formats makes this hard without the right technology.
- [How to Resolve HCC Gaps](https://www.raapidinc.com/blogs/how-to-resolve-hcc-gaps-healthcare-providers/): Identifying and closing gaps that reduce accountable care organization reimbursement from CMS.
- [Outpatient CDI: Accuracy Without Provider Burnout](https://www.raapidinc.com/blogs/outpatient-cdi/): Balancing documentation integrity against physician workload in outpatient clinical documentation improvement.
- [Reducing Provider Abrasion with Integrated Solutions](https://www.raapidinc.com/blogs/provider-abrasion-integrated-solutions/): How administrative friction from risk adjustment requirements affects both operational efficiency and care quality.
- [AI for Risk Adjustment: Build or Buy](https://www.raapidinc.com/blogs/ai-risk-adjustment-build-vs-buy-decision-guide/): The decision framework for building risk adjustment AI in-house versus buying a purpose-built platform.

## Technology and AI Architecture

- [How Neuro-Symbolic AI Enables Defensible Coding](https://www.raapidinc.com/blogs/neuro-symbolic-ai-in-risk-adjustment/): Neural networks read unstructured clinical notes; symbolic reasoning checks each finding against coded clinical rules and MEAT evidence, producing a transparent evidence trail.
- [Why Most Healthcare LLMs Cannot Handle HCC Coding](https://www.raapidinc.com/blogs/healthcare-llms-medical-coding-accuracy/): Where general-purpose large language models fail at HCC validation, and what symbolic reasoning over a clinical knowledge graph adds.
- [From Prediction to Explanation: Clinical AI and Audit Defense](https://www.raapidinc.com/blogs/clinical-ai-radv-audit-defense-ma-plans/): Why traditional NLP falls short of current audit standards, and what clinical reasoning changes.
- [5 Questions to Ask About Healthcare AI Security Architecture](https://www.raapidinc.com/blogs/healthcare-ai-security-5-questions/): Evaluating vendor encryption standards, access controls, audit logging, fault tolerance, and third-party validated infrastructure.
- [Debunking the Myths Around AI in Medical Coding](https://www.raapidinc.com/blogs/debunking-the-myths-around-ai-in-medical-coding/): Common misconceptions about where AI helps and where coder expertise remains essential.
- [Ethical Dimensions of AI in Risk Adjustment](https://www.raapidinc.com/blogs/ethical-dimensions-of-ai-risk-adjustment/): Balancing financial sustainability against equitable patient care in AI-assisted risk adjustment.

## Vendor Selection

- [Top Risk Adjustment Vendors to Compare in 2026](https://www.raapidinc.com/blogs/top-4-risk-adjustment-vendors-2026/): Comparison framework centered on one question — can the tool prove every diagnosis it submits? Covers RAAPID, Navina, and CodaMetrix.
- [Risk Adjustment Companies: A 2026 Buyer's Guide](https://www.raapidinc.com/blogs/risk-adjustment-coding-companies/): How to evaluate risk adjustment partners on audit readiness rather than raw RAF totals, now that V28 is at 100 percent and OIG audits are expanding.
- [Risk Adjustment Software: A 2026 Buyer's Guide](https://www.raapidinc.com/blogs/risk-adjustment-software/): What separates a defensible platform from a liability, against a backdrop of quarterly RADV cadence and nine-figure False Claims Act settlements.

## Segment Guides

- [Risk Adjustment for ACOs: AI-Driven Strategy for Chief Medical Officers](https://www.raapidinc.com/blogs/risk-adjustment-for-acos-chief-medical-officers/): Aligning reimbursement with patient outcomes in risk-based contracting for accountable care organizations.
- [PCP-Centric Risk Adjustment Programs](https://www.raapidinc.com/blogs/pcp-centric-risk-adjustment-program/): Accounting for patient risk differences to support primary care sustainability under capitation.
- [Bridging the Risk Adjustment Continuum for Payer-Provider Success](https://www.raapidinc.com/blogs/risk-adjustment-continuum-payer-provider-success/): Why a collaborative, multidisciplinary approach across the full continuum outperforms siloed programs.
- [Best Practices for Profitable and Compliant Risk Adjustment Programs](https://www.raapidinc.com/blogs/health-plans-compliant-risk-adjustment-program/): How health plans use CMS advance notices to adapt early to risk adjustment changes.
- [AI for Annual Wellness Visit Management](https://www.raapidinc.com/blogs/boost-annual-wellness-visits-ai-medical-directors/): Why medical directors are applying AI to AWV completion, which has risen from 1 to 17 percent of eligible populations.
- [Increasing Medicare Advantage Star Ratings Through Risk Adjustment](https://www.raapidinc.com/blogs/increase-medicare-advantage-star-ratings/): How an effective risk adjustment program affects performance across the 42 measures in the Star Ratings system.
- [The Move to MA Encounter Data, Part I](https://www.raapidinc.com/blogs/cms-ma-encounter-data-risk-adjustment-shift/): CMS proposed shifting risk adjustment from fee-for-service claims to MA encounter data, potentially effective as early as CY 2027.
- [The Move to MA Encounter Data, Part II](https://www.raapidinc.com/blogs/rethinking-risk-adjustment-ma-encounter-data/): What the finalized 2026 payment policy updates confirmed about the encounter data transition, and the pitfalls that remain.

## Case Studies

- [Multi-State Health Plan: $3 Million in Additional Revenue](https://www.raapidinc.com/case-studies/multi-state-health-plan-3-million-revenue/): AI-powered chart review generated $3 million in additional revenue while maintaining audit-ready defensible coding.
- [Florida Medical Group: Closing Diagnosis Gaps](https://www.raapidinc.com/case-studies/florida-medical-group-diagnosis-gaps/): AI-driven pre-visit planning unlocked $11.6 million through defensible prospective coding, with coders reporting 5x productivity.
- [Regional Health Plan: 28% More Defensible Codes](https://www.raapidinc.com/case-studies/regional-health-plan-28-percent-more-codes/): Stronger evidence-to-code alignment captured 28 percent more net-new defensible codes and $4.8 million in incremental revenue.
- [Provider-Owned Payer: Recapturing Revenue Across Fragmented Data](https://www.raapidinc.com/case-studies/multi-state-provider-owned-payer-recapture-revenue/): EHR-agnostic AI overcame data silos and manual review bottlenecks across an entire network.
- [Fortune 500 Health System: Accuracy Benchmarks with PHI Sovereignty](https://www.raapidinc.com/case-studies/fortune-500-health-system-accuracy-benchmarks/): Azure-native Neuro-Symbolic AI reached 86 percent defensible accuracy in this deployment while maintaining full PHI data sovereignty.

## Ebooks and Solution Briefs

- [The Blind Spots in RADV Readiness: 2026 Edition](https://www.raapidinc.com/ebooks/radv-audit-readiness-guide-2026/): Where organizations believe their RADV exposure is controlled and audit outcomes suggest otherwise.
- [Defensible by Design: What Neuro-Symbolic AI Solves That Traditional AI Cannot](https://www.raapidinc.com/ebooks/neuro-symbolic-ai-audit-defensibility-guide/): Why a vendor can report high accuracy while CMS still rejects the codes — an architecture problem, not a tuning problem.
- [The Hidden Cost of Inaccurate Retrospective Risk Adjustment](https://www.raapidinc.com/ebooks/retrospective-risk-adjustment-playbook/): How inaccurate risk data distorts medical loss ratio and erodes plan profitability.
- [Closing the Prospective Risk Timing Gap](https://www.raapidinc.com/ebooks/prospective-risk-adjustment-timing-guide/): Most organizations see patient risk clearly but only after care decisions are locked in.
- [Clinical Knowledge Graphs and Coding Accuracy](https://www.raapidinc.com/ebooks/clinical-knowledge-graph/): Why symptoms, labs, and diagnoses living in silos caps coding accuracy and delays ROI.
- [Document AI Beyond OCR](https://www.raapidinc.com/ebooks/document-ai-overview/): Roughly 70 percent of healthcare data is unstructured, and traditional OCR cannot interpret it.
- [Stop Revenue Leakage with Retrospective Risk Adjustment](https://www.raapidinc.com/brochures/retrospective-risk-adjustment-solution-brief/): Solution brief on why traditional NLP misses codes and cannot defend what it finds.
- [Prospective Risk Adjustment Without Burnout](https://www.raapidinc.com/brochures/prospective-risk-adjustment-guide/): Solution brief on closing care gaps at the point of care, when insights arrive in time to matter.

## Webinars

- [RADV Is Accelerating: Your Defensible Coding Playbook for 2026](https://www.raapidinc.com/webinars/radv-accelerating-defensible-coding-playbook-2026/): PY 2020 audits began February 2026. Preparing to defend every diagnosis.
- [V28 Beyond the 2026 Transition](https://www.raapidinc.com/webinars/v28-beyond-2026-transition-risk-adjustment-program/): The V28 transition is complete and the audits have started. What that means operationally.
- [Understanding CMS's AI Strategy](https://www.raapidinc.com/webinars/cms-ai-strategy-risk-adjustment-2026/): How CMS is deploying AI in oversight, and what that changes for risk adjustment programs.
- [2026 Risk Adjustment Outlook: CMS Changes, AI Trends, and Q1 Priorities](https://www.raapidinc.com/webinars/2026-risk-adjustment-outlook-cms-ai-trends/): What continued V28 implementation and CMS policy updates mean for HCC capture and coding workflows.
- [Building Compliant Workflows and Evaluating AI Vendors](https://www.raapidinc.com/webinars/defensible-coding-workflows-risk-adjustment/): From regulatory context to operational reality in defensible-by-design workflow construction.
- [The Evolution of AI: From Machine Learning to Neuro-Symbolic](https://www.raapidinc.com/webinars/traditional-ai-fails-risk-adjustment-neuro-symbolic/): Why traditional AI fails in risk adjustment and what the next generation looks like.
- [The Changing Landscape of Medicare Advantage](https://www.raapidinc.com/webinars/new-medicare-advantage-reality-risk-adjustment/): Why business-as-usual in Medicare Advantage has become existential risk.
- [Modernizing RADV Prep With Clinical AI](https://www.raapidinc.com/webinars/modernizing-radv-prep-clinical-ai/): For RADV leaders, coders, and compliance professionals moving from paper-based prep to predictive workflows.
- [From Chaos to Compliance: Mastering RADV Documentation](https://www.raapidinc.com/webinars/radv-compliance-documentation/): A step-by-step action plan for protecting against clawbacks.
- [Beyond the RADV Checklist](https://www.raapidinc.com/webinars/beyond-the-radv-checklist/): What expanded CMS RADV audits mean financially, covering short-term survival and long-term revenue protection.
- [RAAPID's RADV Webinar Leadership Series](https://www.raapidinc.com/blogs/radv-webinars-audit-defense/): Four-part series led by Wynda Clayton, Director of Risk Adjustment Coding and Compliance, with Chris Lally, VP of Operations.

## Upcoming and Recent Events

- [RAAPID at RISE West 2026](https://www.raapidinc.com/events/rise-west-2026/): A private dinner for senior leaders in risk adjustment, value-based care, and compliance. No panels or slides.
- [RAAPID at the 2026 RISE Value-Based Care Summit](https://www.raapidinc.com/events/rise-vbc-2026/): Document it at the visit, defend it all year — how point-of-care documentation holds up under audit.
- [RAAPID at Becker's 16th Annual Meeting 2026](https://www.raapidinc.com/events/beckers-2026/): Demonstrating two-way review with adds and deletes.
- [RAAPID at RISE National 2026](https://www.raapidinc.com/events/rise-national-2026/): Neuro-symbolic reasoning combined with deep learning for audit-defensible coding at scale.
- [RAAPID at the 4th Annual Risk Adjustment Innovations Forum](https://www.raapidinc.com/events/4th-annual-risk-adjustment-innovations-forum/): Replacing chaotic vendor management and manual processes with explainable AI.
- [RAAPID at the 26th Risk Adjustment Forum](https://www.raapidinc.com/events/26th-risk-adjustment-forum/): AI-powered coding outcomes for risk adjustment leaders.
- [RAAPID at HLTH USA 2025](https://www.raapidinc.com/events/hlth-2025-las-vegas/): Meeting availability and demo scheduling for HLTH attendees.
- [RAAPID at NAACOS Fall 2025](https://www.raapidinc.com/events/naacos-fall-2025/): End-to-end risk adjustment coverage across the patient journey, for ACO leaders.

## Press Room

- [RAAPID Featured in KLAS Emerging Company Spotlight for Defensible Coding](https://www.raapidinc.com/press-room/raapid-klas-emerging-company-spotlight-2026/): An A+ would-buy-again grade (Emerging Data, n=5) in the May 2026 KLAS Emerging Company Spotlight, with interviewed customers citing AI accuracy and audit defense.
- [RAAPID Achieves HITRUST r2 Certification](https://www.raapidinc.com/press-room/raapid-achieves-hitrust-r2-certification/): June 1, 2026 — the RAAPID Platform on Microsoft Azure East earned HITRUST certified status for cybersecurity and information protection.
- [Healthworx Joins Microsoft and UPMC Enterprises as RAAPID Investor](https://www.raapidinc.com/press-room/healthworx-investment-strategic-industry-trifecta/): Strategic investment from Healthworx, the investment arm of CareFirst, making RAAPID the only risk adjustment platform backed simultaneously by M12, UPMC Enterprises, and a top-tier payer investor.
- [RAAPID Secures Series A Extension from UPMC Enterprises](https://www.raapidinc.com/press-room/upmc-enterprises-series-a-extension-raapid-clinical-ai/): Additional Series A investment from UPMC Enterprises to scale Neuro-Symbolic AI-powered medical coding.
- [RAAPID Wins 2025 Modern Healthcare Best in Business Award](https://www.raapidinc.com/press-room/raapid-wins-modern-healthcare-best-in-business-2025/): January 2026 — recognized in the Healthcare IT category for the Novel Clinical AI Platform.
- [RAAPID Earns Microsoft Healthcare AI Certification](https://www.raapidinc.com/press-room/raapid-earns-microsoft-healthcare-ai-certification/): October 2025 — Microsoft Healthcare AI Certified Software designation for clinical relevance, data privacy, and responsible AI.
- [RAAPID Launches the First Autonomous Novel Clinical AI Platform](https://www.raapidinc.com/press-room/novel-clinical-ai-platform-launch/): Neuro-Symbolic AI platform launch for health plans and health systems.
- [RAAPID Unveils AI-Powered RADV Audit Solution at RISE West 2025](https://www.raapidinc.com/press-room/raapid-unveils-radv-audit-solution-rise-west-2025/): Industry-first complete RADV audit solution for health plans.
- [Kim Swafford Joins RAAPID Advisory Board](https://www.raapidinc.com/press-room/kim-swafford-joins-raapid-advisory-board/): September 2025 — Microsoft Healthcare Industry Executive appointed to the advisory board.
- [Don Antonucci Joins RAAPID Advisory Board](https://www.raapidinc.com/press-room/don-antonucci-joins-raapid-advisory-board/): July 2025 — Providence Health Plan President and CEO, bringing over 25 years of payer leadership.
- [Terry Shaw Joins RAAPID Advisory Board](https://www.raapidinc.com/press-room/terry-shaw-joins-raapid-advisory-board/): July 2025 — former AdventHealth President and CEO, with deep clinical operations and financial performance expertise.
- [RAAPID Raises Series A from M12, Microsoft's Venture Fund](https://www.raapidinc.com/press-room/microsoft-m12-backs-raapid-series-a-healthcare-ai/): Series A round alongside reported 300 percent revenue growth in 2024 and partnerships with leading health systems.
- [RAAPID Achieves HITRUST r2 and i1 Certification History](https://www.raapidinc.com/press-room/raapid-achieves-hitrust-i1-certification-for-second-consecutive-year/): July 2025 — HITRUST i1 certification for the second consecutive year.
- [RAAPID Great Place To Work Certified for Second Consecutive Year](https://www.raapidinc.com/press-room/raapid-great-place-to-work-certified-2025/): October 2025 — certification awarded based exclusively on employee feedback.
- [Wynda Clayton and Derek Haynes Join RAAPID Leadership](https://www.raapidinc.com/press-room/wynda-derek-join-raapid/): March 2025 — Director of Risk Adjustment Coding and Compliance, and Director of Partner Alliances.
- [RAAPID Joins Microsoft for Startups Pegasus Program](https://www.raapidinc.com/press-room/raapid-joins-microsoft-for-startups-pegasus-program/): Transactable Azure Marketplace offer through Microsoft's startup acceleration program.