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AI-Powered Risk Adjustment Compliance

Apixio’s HCC Auditor solution uses AI to flag submitted HCC codes without sufficient supporting evidence, giving compliance teams a clear picture of potential audit risk and coding problem areas.

HCC Auditor Chart Review Workflow - 2020

Maximize your accuracy and reduce audit risk

The ultimate in accuracy and audit protection

It is essential to “look both ways” in every retrieved chart, but the process is expensive and time-consuming. Apixio’s HCC Auditor solves these problems for your organization. Each retrieved chart is analyzed to determine the source for a reported code. Source notes are then assessed using our industry-leading machine learning algorithms to determine whether the required supporting elements are present. Coders can then make the final determination using an easy-to-use web-based application. This augmented intelligence approach helps assure your organization that you are taking the right steps for accuracy.

Screenshot of HCC Auditor

Using Apixio’s HCC Auditor, powered by our AI platform, you’ll be able to:

  • Analyze retrieved patient charts to identify source encounter notes for reported diagnosis codes
  • Validate whether encounter notes have the required elements to support HCC codes based upon your guidelines
  • Report validated and unsupported codes
  • Confirm the integrity of your HCC submissions

Fast Facts

0 %
of HCC submissions come from provider claims data
0 %
Medicare payments lacking sufficient documentation [$6.7Billion in 2014 ]
0 %
Claims incorrectly coded
Capital Blue Cross Health Plan

The efficiencies Apixio brings to our reviews are just incredible. Their machine learning technology leads you to the right information you need for coding.

Andrew Bloschichak MD, MBA
Senior Medical Director, Government Programs - Capital Blue Cross
network health

The coding team was wonderful to work with, and incorporated our specific coding guidelines when working on our project. When they noticed a trend in what we were rejecting, they shared a Coding Clinic we were unaware of for clarification on how to code the scenarios.

Josh Weisbrod
VP of Risk Adjustment
Scripps logo

By using Apixio, we’re improving our auditing bandwidth and enhancing the ability of our coders to focus on other chart audits and other projects that we couldn’t do before.

JoAnn Hayden
Scripps Health Plan Services
Case Study

Capital Blue Cross

Fast Facts: Second-Pass Coding 33,500 charts reviewed +5% RAF score increase between…

View Case Study
Case Study

How a Veteran Coder Used Apixio’s HCC Identifier to Eliminate Data Entry Error and Double Productivity

Fast Facts Increased productivity from 3 charts per hour to 10 charts…

View Case Study
Case Study

Sigma Health Plan

Fast Facts 70,000 lives reviewed 983 new HCC codes 98.5% coding accuracy…

View Case Study
See how our risk adjustment compliance solutions can help your organization maintain accuracy while eliminating audit risk.