Proactively Prepare, Validate, and Defend HCC Submissions
RADV audits have become a year-round operational priority for Medicare Advantage organizations and payers. Our RADV solution uses healthcare-specific NLP and LLMs to automate chart review, evidence validation, and HCC reconciliation.
Identify documentation gaps early, reduce risk exposure, and generate audit-ready outputs at scale - before CMS auditors do.
The Challenge
Why RADV Readiness Matters
RADV audit scope and rigor continue to increase - making it essential to ensure each submitted HCC is supported by complete, defensible documentation and clear traceability.
Common pain points we solve:
Manual chart review that doesn't scale
Difficulty proving clinical evidence sufficiency
Inconsistent validation of documentation standards (e.g., MEAT gaps)
Risk of recoupments due to unsupported diagnoses
How It Works
Ingest
Charts & coded diagnoses at scale
AI Review
NLP/LLM documentation gap analysis
Risk Scoring
HCC evidence packs & prioritization
Audit-Ready
Mock audits & CMS submission
Our Solution
What Our RADV Solution Delivers
A modern RADV audit readiness platform that helps you find issues before auditors do, automate evidence packets, and strengthen defensibility.
Automated Chart Review
Automated chart review and evidence validation to detect missing or non-defensible documentation at scale.
HCC Coding Reconciliation
Identify gaps and discrepancies between clinical documentation and HCC submissions before auditors find them.
Audit Scoring & Benchmarking
Audit-readiness reporting mapped to CMS criteria with cohort-level benchmarks for proactive risk management.
Evidence Packs
Explainable evidence packs and audit-ready reports to support review prioritization and audit defense.
MEAT Validation
Documentation gap detection including unsupported diagnoses and missing MEAT (Monitor, Evaluate, Assess, Treat) evidence.
Secure Deployment
Customer-controlled deployment (containerized) with HIPAA-aligned processing to maintain PHI control.
Process
How It Works
A simple, executive view of our RADV readiness workflow.
Ingest
Ingest charts and coded diagnoses from your environment at scale.
AI Review
AI reviews documentation using healthcare-trained NLP/LLMs to flag gaps.
Risk Scoring
Generate risk scoring and evidence packs so teams focus where it matters.
Audit-Ready
Produce audit-ready outputs supporting mock audits and CMS readiness.
Target Audience
Who It's For
Built for organizations operating in high-compliance risk adjustment environments.
Medicare Advantage Organizations
Risk Adjustment & Coding Teams
ACOs
Audit & Compliance Teams
Results
Outcomes You Can Expect
Reduced Exposure
Identify documentation gaps and unsupported diagnoses prior to audit submission.
Less Manual Effort
Automated review and evidence packet generation at scale.
Improved Defensibility
Explainable evidence packs, scoring, and audit-ready reporting.
Scalable Readiness
Support internal mock audits and ongoing monitoring workflows.