“HCC Profiler has amplified our auditing bandwidth, empowering our coders to prioritize higher-level projects that they simply couldn’t do before.”

Jennifer Pereur, Director of Government Programs, Hill Physicians

“We're 50/50 with EHR reviews and with traditional chart chase PDF reviews, and [this tool has] really added some value to that PDF review for us, in particular.”

Alicia Wilbur, Risk Adjustment Operations Manager, Martin's Point Health Care

The Leading Technology for
Medicare Advantage and Commercial Risk Adjustment

Built on the analysis of millions of patient charts, HCC Profiler utilizes advanced natural language processing, pattern recognition, and machine learning to streamline risk adjustment.

HCC Profiler is the fastest, most accurate, most complete risk adjustment solution. It is available as a cloud-based application or technology-enabled service.

Unleash the Power of
HCC Profiler

  • Simple EHR
    Chart Acquisition
  • Robust OCR for
    Scanned Chart Analysis
  • Coding and
    Project Insights
  • One-Click,
    Complete QA
  • Streamlined Coding Application

Available as an
Application or Service

Application

Have your own coding team? Want to bring risk adjustment in-house?

Take control of your risk adjustment coding with your in-house team

  • Reduce time required to code by 80% or more
  • Complete QA of all coding results
  • Secure rich project insights on demand
  • Free your team for training and education
or

Service

No coding team?
No problem.

Gain confidence in your risk adjustment without a large coding team

  • Increase accuracy with fewer resources
  • Use our expert coders, armed with your coding guidelines
  • Complete up to 100% of QA yourself, in just days
  • Get regular updates on the data analysis and chart review process

Tackle Both Sides of Risk Adjustment with
HCC Profiler’s Two Solution Suites

Coding

Find New Supported Codes

As an application or a service, your organization will benefit from the accuracy, efficiency and deep insights that HCC Profiler enables in your first or second pass coding program efforts.

  • Accurate & Fast
    • Complete your coding in up to 80% less time than traditional review methods
    • Enables up to 3 levels of quality assurance
    • Supports diverse chart acquisition methods from EHR direct access to scanned and pdf charts
  • Efficient
    • Present HCC coding opportunities in a streamlined user-centric workflow
    • Uses built-in smart ICD code and provider search to assist data entry
    • Presents individual coding opportunities with supporting evidence so coders don’t have to read entire charts
  • Deep Insights
    • Provides real-time coder metrics (accuracy & productivity) in an easy to navigate graphical interface
    • In-app project management tools like user administration, data management and QA progress provide a comprehensive overview on coding progress and resource allocation 

Compliance

Confirm Current Codes

Verify that reported HCC’s have sufficient evidence for CMS submission and protect your organization from costly audit and coding compliance failure with one of the modules from Apixio’s compliance suite.

  • Compliance Auditor
    • Enables audit of 100% of vendor coding results, increasing project visibility while reducing audit risk
    • Ensures adherence to your coding guidelines and that all codes are properly documented and supported
  • Zero Evidence
    • When combined with our coding offering, this report identifies submitted codes that have no supporting evidence in retrieved charts
    • Flags potential deletes for further investigation and  audit risk mitigation
  • Code Validation
    • Is the most robust risk adjustment compliance solution on the market today. It validates the accuracy of HCC submissions by linking all HCC’s to available source encounter notes
    • Identifies unsupported codes and confirms the integrity of the HCC submission pipeline

CASE STUDY

How Sigma Health Plan* Increased Risk Capture and Validated Accuracy with HCC Profiler

A large payer‑provider in a major metropolitan region, Sigma Health Plan* lacked the capacity to review all its Medicare Advantage charts for completeness and accuracy. Charts from their contracted physician population, in particular, were going unchecked. They realized that to elevate the quality of their risk adjustment review, they would need the help of technology.

Bottom Line:

•  70,000 lives reviewed.

•  983 new HCC codes, delivered in less than 5 weeks.

•  98.% new code agreement. 

•  In 2017, SHP* will use HCC Profiler across MA and            

   commercial population.

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Read more here

Learn More About HCC Profiler

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