Risk Adjustment Solution for Commercial Risk Adjusted Plans


Reduce your risk of payment transfer

Reduce the likelihood that you will make transfer payments to your competitors by ensuring that all properly documented, HHS- HCC risk adjusting conditions are coded and reported for your commercial exchange plan member population with the HCC Optimizer. More accurately capture and report all chronic and acute conditions with the Apixio smart HHS-HCC analytics and HCC Optimizer coding application.

Improve your RAF scores

Ensure that your RAF scores accurately represent the health of your commercial members based on the source of clinical documentation, not just the claims stream. The HCC Optimizer solution will analyze patient medical records obtained via automated chart extraction, and identify members and encounters with a high likelihood of containing a properly documented risk adjusting condition. Certified coders then review only those members’ charts with potential risk adjusting diagnoses that have not been reported previously.

Capture all properly documented diagnoses in your member's medical records 

Don't only rely on diagnosis codes reported through the claim stream but go directly to the source of clinical documentation. The HCC Optimizer analyzes each and every member’s medical record and only presents for HHS-HCC coder validation qualified face-to-face encounter notes from relevant Dates-of-Service. The outcome of which is faster, more accurate coding of 100% of your commercial exchange plan members.

Attain HHS RADV audit confidence

Easily retrieve the supporting encounter note for every coder approved HHS- HCC condition enabling you to easily identify and retrieve the associated medical record in the event of an HHS RADV audit.

                                                                                                                                                                                                                                                                                                  Learn more about the HCC Optimizer 

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