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
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.
Make the Most out of RAAPID’s AI Risk Adjustment Technology
Our Extended Risk Adjustment Services
HCC Coding
A full spectrum of retrospective coding services for health plans, ranging from compliance support to RADV audit preparation.
Chart Review
A risk adjustment coding service provider that provides accurate and reliable review services for health plans.
Chart Audit
Perform HCC coding analysis to ensure accuracy and the goal of maximizing reimbursement while reducing disputes.
Risk Adjustment Insights for Health Plans
Why RAAPID’s Risk Adjustment Technology Solutions and Services for Health Plans
NLP
Our NLP technology into chart review and claim comparison processes provides faster analysis with higher accuracy rates at lower costs compared to traditional methods.
Knowledge Graph
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.
OCR
Quickly extract important information from insurance claim forms, making it easier to identify potentially fraudulent claims or errors before they are processed.
ML/DL AI
Improve the accuracy, efficiency, and consistency of chart reviews by automatically identifying potential errors, discrepancies, or anomalies.
API
Through our clinical APIs confidently share critical information across disparate systems leading and improve efficiencies across workflows.
How Do We Support You
Your Personalized AI-Powered Risk Adjustment Coding & QA Platform
Client Testimonials
FAQs related to health plans
NLP can analyze large amounts of data from various sources such as electronic medical records and claims to identify patterns that may indicate fraud or abuse.
NLP for second-level review allows for a more precise analysis of clinical documentation, helping to identify any missed diagnoses or incorrect ICD-10/HCC coding that could impact risk adjustment scores.
Yes. The technology is capable of identifying patterns in patients’ health records that might have gone unnoticed otherwise.
Health plans may not have the resources or staff necessary to efficiently manage chart reviews and audits on their own, when considering the increasing number of Medicare and Medicaid/Medi-cal enrollees v.s the tight diagnosis codes data submission deadlines.
Outsourcing allows health plans focus on other important areas while still ensuring compliance with regulations.
Selecting the right NLP service and solution vendor requires careful consideration of both technical capabilities and cultural fit with your organization.
By partnering with RAAPID as you can ensure the above.