AI-Powered Risk Adjustment Platform for Payers
AI-POWERED RISK ADJUSTMENT
Smarter Risk Adjustment, Better Accuracy, Measurable Outcomes.
Enhance RAF accuracy, close coding gaps, and identify undiagnosed conditions with an integrated platform that unifies claims, clinical, and pharmacy data driving proactive, compliant risk adjustment at scale.
End-to-end Risk Adjustment Solutions for Payers
Full Visibility for Risk Adjustment Performance
- Identify and surface open coding and care gaps across member populations in real time
- Prioritize outreach efforts with intelligent chase lists ranked by member and provider opportunity
- Receive AI-driven recommendations for care pathways and next-best actions to close gaps efficiently
Proactive Gap Closure at the Point of Care
- Surface gaps & suspect codes before the patient visit to enable timely intervention
- Close gaps with Pharmacy Copilot to drive medication adherence and at-home test kits to streamline closure of care gaps beyond the clinical setting
- Provider Copilot delivers in-workflow insights to support accurate documentation and coding
Retrospective Intelligence for Complete and Compliant Risk Capture
- Identify and capture previously unsubmitted or undocumented diagnosis codes to improve RAF scores
- Detect missed coding and documentation gaps across historical clinical and claims data
- Leverage bi-directional claims and chart reviews for comprehensive and accurate risk adjustment
Chart Retrieval for Accurate Risk Scoring & Audit Readiness
- Risk Adjustment & HCC Coding
- Charts to be retrieved to support RADV & Audits
- Enhances risk visibility by integrating chart data with coding and analytics workflows.
Powered by a unified data model that links disparate data sources
Labs, Pharmacy, Claims, EMRs, SdoH, Consumer & Digital Health, Third-party Data
3X more accurate than off-the-shelf AI
- Raw data is received from source systems & stored in a data lake.
- Patient & provider information are aggregated into a single record.