Prospective and Concurrent Risk Adjustment

Improve Point-of-Care Risk Capture and Care Delivery with AI

Surface actionable condition insights at the point-of-care with AI-powered solutions that streamline prospective risk capture and support complete, accurate coding and documentation.

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Lighten Your Administrative Load While Closing More Diagnosis and Documentation Gaps

Prospective and concurrent diagnosis capture, documentation, and coding activities are critical as value-based reimbursement programs continue as the market matures. But manual processes, disconnected workflows, and ad-hoc communications make it difficult for providers to scale support for these important administrative programs while also delivering timely, informed care to patients.

With Apixio’s AI-powered and EHR-integrated prospective and concurrent risk adjustment solutions, clinical documentation integrity (CDI) specialists, reviewers/coders, and clinical teams are able to effectively work together to close care gaps and ensure complete, accurate clinical documentation while streamlining processes across pre-visit planning, point-of-care, and post-encounter reviews.
Close Diagnosis Gaps Faster And With Less Friction
Ensure Complete Documentation And Coding
Reduce Administrative Overhead
Benefits

Transform Data Into Insights

Distill structured and unstructured data into a comprehensive view of actionable patient insights.

Simplify Pre-Visit Planning

Review recaptured and suspected conditions in a centralized, AI-powered workflow.

Share Condition Insights Seamlessly

Send reviewer-triaged insights directly to your EHR for clinical assessment.

Accelerate Concurrent Reviews

Quickly ensure complete diagnosis capture and documentation before claims submission.

Amplify Point-of-Care Risk Capture and Care Delivery

Identify

Prospective Insights

Boost your prospective programs using AI-powered analytics distilled from structured and unstructured data, empowering organizations with actionable suspected and recaptured insights and flexible delivery options that increase diagnostic accuracy and refine member prioritization, pre-visit evaluations, and outreach initiatives.
Improve upstream risk capture
Review AI condition suspects and recapture insights
Deliver into existing workflows

Prepare

Pre-Visit Planning

Amplify pre-visit chart prep processes with Apixio’s prospective workflow solution that presents AI-driven diagnostic gaps (from structured and unstructured data sources) alongside highlighted evidence. Intelligent reviewer workflows significantly streamline the identification of risk-adjustable health conditions and enhance clinical and operational efficiency.
Review charts 5x faster with AI-assisted workflows
Longitudinal patient view with evidence-based insights
Dual V24/V28 model approach creates coding efficiency

Capture

Point-of-Care Workflows

Deliver trusted, evidence-based AI insights from structured and unstructured data seamlessly to the point-of-care leveraging advanced EHR integration. Care teams are empowered to bridge exceptional patient care and diagnostic precision effectively, improving clinical outcomes and streamlining workflows.
Agnostic EHR integration with advanced write-back
Increase provider engagement and acceptance
Track program with performance metrics

Validate

Concurrent Review

Apixio's AI-driven, EHR-integrated concurrent workflow solution ensures accurate diagnosis capture and documentation completeness before claims submission, driving compliance and enabling scalable review processes across patient populations for enhanced accuracy and unsurpassed efficiency.
Ensure diagnosis capture and documentation completeness
Resolve discrepancies prior to claims submission
Effectively scale across at-risk populations

Features

Comprehensive view of clinical and administrative data by patient

AI-powered diagnosis gap suspect and recapture conditions

Clinical workflow integration using APIs or EHR connectors

Intelligent work queue with customizable filtering logic and evidence highlighting

Query clinical staff within EHR workflows to streamline gap closure

Monitor and track clinically-amended encounters in real time

AI-as-a-Service for Prospective and Concurrent Risk Adjustment

Recapture known patient conditions and close diagnosis gaps at the point-of-care with flexible AI services delivered in any workflow.
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Streamline and Scale Prospective and Concurrent Risk Adjustment Programs with Apixio

Explore how Apixio can support your organization’s unique prospective risk adjustment and care delivery needs.