Act before the opportunity is lost.
Our prospective AI models identify members with potentially undocumented or under-documented conditions. They prioritize members and suspected conditions using clinical and claims signals, then create actionable workflows for providers and for risk-adjustment and medical management teams.
This moves Risk Adjustment from retrospective chart review to proactive intervention.
Why it matters
Looking back is slow and costly
Retrospective chart review finds conditions months after the visit, when they are hardest to confirm and most expensive to chase.
Accuracy is under scrutiny
CMS audits of risk adjustment data (RADV) put codes that the medical record does not support at risk of recovery.
It has to fit the provider's day
Insights that arrive outside the provider's workflow are not used. They need to be in front of the clinician before the patient is.
How we work
Find suspected conditions
From clinical and claims signals, prioritized by the members and conditions that matter most.
Bring them to the point of care
Actionable workflows for providers, so the conversation happens during the visit.
Confirm and close
Workflows for risk-adjustment and medical management teams, and tracking of what was confirmed.
What the work covers
- Suspect identification from clinical and claims signals
- Member and condition prioritization
- Actionable workflows for providers
- Workflows for risk-adjustment and medical management teams
- Coding quality and compliance review
- RADV audit readiness
Common questions
Have a question that is not here?
Ask our teamWhat is prospective risk adjustment?
Finding and confirming members' health conditions before or during a visit, so they are documented accurately at the time of care rather than found later in chart review.
How is it different from retrospective review?
Retrospective review searches past charts for missed conditions. Prospective work acts before the opportunity is lost, which is faster, cheaper and better for member care.
Does it apply beyond Medicare Advantage?
Yes. Medicaid managed care and ACA plans also use risk adjustment models, and the same approach applies to each.
How do you keep it compliant?
Every condition must be supported by the medical record. We review documentation against the official coding guidelines and prepare for audit from the start.
Related services
Measurable P&L impact. Every time.
Across medical expense, administrative cost, and risk-adjusted revenue, our focus is the same: AI must translate into financial results, not just another pilot or technology deployment.
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