The current efficacies of Health care Industry with Accurate Risk Adjustment Models
Risk Adjustment for healthcare payers and providers determines the coverage rate for patient care and accurately maps the population’s risk burden. A well-crafted risk-adjustment solution is pivotal to properly lining up incentives and protecting risk-bearing healthcare providers and payers.
Today, the healthcare payers and Providers perceive the Internet of Medical Things (IoMT), AI-powered tools, as one of the next-generation healthcare technology trends. In addition, AI is also helping healthcare payers and providers adopt automation and efficiency for multiple administrative workflows within the healthcare ecosystem.
Role of AI and NLP in Risk adjustment
For a health care payer and provider to ensure its population’s risk burden is accurately mapped, exquisite technology tools must be used to monitor encountered data, segregate aberrancies, and quickly and efficiently address any errors, if any.
NLP in the insurance industry allows to analyze unstructured patient’s clinical notes, create reports, transcribe the patient’s interactions, and perform conversational AI. Adopting NLP, AI and machine learning solutions will help your insurance company to get rid of manual, paper-based clinical and administrative processes which repetitive, error-prone, and time-taking too.
How do Insurance companies and Medical coding companies use AI to mitigate risk
AI-enabled analytics will help you transform your insurance companies’ chart review operations in accuracy, even for large amounts of data. It will allow you to switch from the traditional chart review process to precision targeting of charts. In addition, its fewer chart retrieval requests will increase the efficiency of each chart review.
Future Trends of AI based tools
- Identify unreported HCC and ICD- 10 diagnosis codes
- Identify suspects while chart
- Access to patient’s health history
- Automate the risk adjustment process
- Access to analytics to improve retrieval rates
- Maximizing coding accuracy and efficiency and completeness.
How does RAAPID work
RAAPID is built for big and small organizations in the healthcare & insurance business. We have got you covered when it comes to HCC Risk Adjustment.
1. Collect Data
Collects and organizes all relevant clinical documents, including unstructured notes
2. Optical Character Recognition
Converts scanned images to text format, using external APIs
3. NLP Technology
Auto combs all unstructured and structured notes to extract clinical entities
4. Patented Ontologies
Patented Knowledge Graph & Custom rules to identify the entity relationships
5. Code Validation
Evidence-based auto-suggested ICD 10 and HCC codes for coder validation
6. Risk Score Calculation
Final RISK score based on Complete, Compliant, and accurate codes
Why is RAAPID the game changer
RAAPID exists to suit your organization’s risk adjustment needs. We are reimagining risk adjustment for healthcare, insurance, and medical coding solutions providers and technology businesses with our AI-Driven Solutions which are smarter, faster, and more accurate.
Getting timely access to healthcare data and insights has been an ongoing challenge for payers and providers. RAAPID’S NLP-driven AI-powered solutions provide flexible data exchange options and push valuable clinical insights to the point of care, reducing provider abrasion and supporting value-based care activities.
RAAPID uses AI for risk adjustment solutions, which eliminates the need for multiple vendors and the overhead expenditure. Usually, Commercial AI technology is built using legacy stack, so they are rigid and unable to meet organizations’ need for modular workflows. RAAPID’s underlying NLP is developed using 10 years of effort. Our NLP is seamlessly integrated into the product as well as offered as an API.
With RAAPID, you get flexible deployment options and Seamless Interoperability
Truly SaaSA complete end to end AI-powered, customizable SaaS application for your Coders and Risk Adjustment team
- Accurately identify patient’s disease burden
- No more missed RAF scoring opportunities
- Ace disease discovery for risk adjustment coding
- Get suspected condition recommendations
- Auto Code Suggestions
APIs we offer
HCC & ICD-10 APIs
Takes Clinical Documents and returns extracted entities codified into HCC and ICD-10-CM/PCS taxonomies.
SNOMED CT, RxNorm & LOINC APIs
Returns Extracted entities codified into SNOMED CT, RxNorm and LOINC codes.
Returns de-identified PHI redacted data.
We develop customized APIs as per your use case, leveraging our deep healthcare expertise.