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The new standard in risk adjustment coding

Take control of your Medicare Advantage, ACA, and MSSP risk adjustment programs with our industry-leading retrospective coding and QA solutions.

Flexible support for government risk programs

Our AI-powered coding & QA solutions are designed for health plans and at-risk providers running retrospective risk adjustment for government programs.
Medicare Advantage
Improve your retrospective coding accuracy, completeness, and efficiency with Ai-powered chart reviews.
Affordable Care Act
Position your plan for competitive risk corridor performance with a comprehensive picture of population risk.
Medicare Shared Savings Program
Protect your ACO's benchmark performance with accurate ICD coding and targeted member outreach.

Is your risk adjustment program capturing the whole truth?

Traditional coding approaches don’t fully capture the underlying risk in a MA population. In a groundbreaking study, coders using Apixio’s HCC Identifier application found 20% more new supported HCC codes than expert coders working without technology assistance in a review of 284,000 MA member charts. In addition to the greater accuracy, coders using the HCC Identifier application were able to code 25 charts per hour (including QA), which is 4 to 6 times faster than traditional coding methods.

Give your organization the best of both worlds by providing your risk adjustment coding team the augmented intelligence difference from Apixio.

Accuracy
Apixio 30,236 HCCs
Traditional Vendor 24,385 HCCs
Performance Gap
Productivity
Apixio 25 Charts/Hr
Traditional Vendor 5 Charts/Hr
Performance Gap

Take control of your risk adjustment program

With HCC Identifier, you can track coder progress and decision-making, provide real-time feedback, and uncover opportunities for training and education. Project dashboards and multi-layered quality assurance provide instant insights into coder decisions and supports a sophisticated oversight and rebuttal process with much less time and effort.

Comprehensive data acquisition
Targeted coding opportunity reviews
Configurable coding & QA workflows
Robust coder management tools

Comprehensive data acquisition

InfoStream by Apixio can ingest large batches of healthcare documents and extract insights from a wide variety of data types, including:

  • Encounter notes from provider EHRs [Epic, Cerner, Allscripts, Athenahealth]
  • PDF or TIFF patient charts from your chart retrieval vendor [Episource, Ciox, Optum, Inovalon, Cotiviti, etc.]
  • Clinical and pharmacy claims
  • Demographic, eligibility, and provider files
  • RAPS return files
  • And more
EHR and Chart Chase Vendors - Retrospective Risk Adjustment
EHR and Chart Chase Vendors - Retrospective Risk Adjustment

Targeted coding opportunity reviews

NLP and machine learning algorithms locate evidence of potential net-new HCCs in patient charts. Coders are pointed to specific pages to review supporting documentation so they can focus their time on high-probability coding opportunities and capture more of the truth with less effort.

HCC Identifier Coding Workflow
HCC Identifier Coding Workflow

Configurable coding & QA workflows

Need a custom routing workflow for assigning charts? Conduct 3 levels of QA to ensure reviewer accuracy? Want to route rejected coding opportunities through an additional blind review to maximize value? You can customize project workflows to align with your organization’s goals and guidelines.

Apixio AI Powered Risk Adjustment Coding Solution
Apixio AI Powered Risk Adjustment Coding Solution

Robust coder management tools

Manage coder assignments, track chart review speed & accuracy, and identify reviewers who need additional education with our flexible application. You can review individual coding and QA decisions with supporting evidence to resolve rebuttals and identify areas for coder training.

HCC Identifier Coder Dashboard
HCC Identifier Coder Dashboard

Fast Facts

0 %
Reduction in time required to code
0 or more*
Levels of quality assurance enabled
0 %
Accuracy increase
0 - 6x
Productivity increase

The most trusted risk adjustment coding technology available

Apixio’s technology is trusted nationwide by health plans, risk-bearing provider groups, and ACOs. We’ve conducted a number of large studies of our machine learning technology and have repeatedly demonstrated that coders have superior accuracy and greater productivity with our application compared with coders using traditional or other technology-enabled coding methods. With learnings from the over 14 million patient charts analyzed to date, we’ve been able to optimize our results and support risk adjustment teams with timely, reliable, actionable insights.

Managing the risks of risk adjustment

Flexible application and coding service options to support your program’s needs

HCC Identifier supports first-pass and second-pass reviews as an application or service offering.

  • Web-based application: Our robust coding application supports in-house teams. Managers have full control over coder assignments, QA workflows, and additional reviews to maximize accuracy.
  • Technology-based service: Our service solution combines the power of Apixio’s AI platform with seasoned coders who use your guidelines to achieve optimal project results.
Request a demo of HCC Identifier to see how AI can make your coding program more accurate and productive.