Risk Management
Leverage AI-driven precision to optimize coding accuracy and assess the risk acuity of your population.
Features
Accurate and compliant member risk coding
Accurately calculate HCC risk scores to assess patient severity, identify coding opportunities, and enhance risk stratification, with support for CMS HCC versions 24 and 28.
Leverage role-based worklists to pinpoint providers managing high-risk, high-cost patients and uncover key opportunity areas.
Streamline retroactive reviews & audits by accessing member clinical summaries directly from EMRs without leaving the member record.
Identify missing codes for recapture, enabling accurate coding and supplemental submission.
Provide suspect code recommendations to improve coding accuracy and assist provider clinical evaluations via point of care intelligence.
Administrative dashboard and worklist to share real-time population risk intelligence with provider offices, pushing clinical diagnosis gaps and coding opportunities for actioning.
Take a Closer Look
Agent Spotlight
Risk Adjustment Coding
Increase reimbursement accuracy and coding compliance while reducing manual review burden.
Detects and applies accurate risk codes to improve documentation integrity, compliance, and reimbursement accuracy.
AgentFoundry is our healthcare native Agentic AI Platform with a library of pre-built agents.
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