Risk Adjustment / HCC Coding

Datavant's Risk Adjustment / HCC Coding solution delivers fast, accurate estimations of member risk using AI-based coding technology. Designed for Medicare Advantage, Medicaid, and commercial health plans, the platform combines a uniquely consolidated approach to chart retrieval and coding to achieve the fastest turnaround times in risk adjustment coding. Trusted by leading health plans for over 45 years, Datavant helps organizations paint an accurate picture of member health, minimize coding errors, and ensure maximum reimbursement by capturing the full complexity and severity of each member's health status.

By identifying and mitigating costly healthcare gaps, Datavant enables optimal patient-provider interactions while its AI-enabled coding tools reduce human error and drive superior operational performance. The platform supports all major health plan types, including Medicare Advantage, commercial health plans, and Medicaid, and is retained by 98% of health plan customers annually.

End-to-End Risk Adjustment Coding Workflow

1. Project Initiation: Establishes data input and output formats along with reporting frequency to align the engagement with client requirements from the outset.
2. Chart Acquisition and Preparation: Retrieves and prepares charts using defined data formats and reporting cadences, ensuring a smooth transition into the coding phase.
3. Coding Review: Analysts review charts and assign diagnosis codes that are supported and risk-adjust, ensuring clinical accuracy throughout the process.
4. Tiered Quality Assurance: Comprehensive quality audits are conducted using targeted, trend-based, and random sampling methods to verify accuracy and completeness across coder, project, and client levels.
5. Results Delivery: Fast and actionable coding data is delivered to enable early decision-making within risk adjustment programs.

Key Coding Capabilities

• Multiple Levels of Review: Datavant offers first-pass coding as well as second- and third-level review to improve the accuracy of previously coded charts, ensuring completeness at every stage.
• Automated Code Review with NLP: Datavant's proprietary AI-enabled coding engine uses natural language processing (NLP) to extract codes from charts and compare them against prior coding results, automating the review process and reducing manual effort.
• Multiplan Support: Risk adjustment coding is available for all major health plan types, including Medicare Advantage, commercial health plans, and Medicaid, providing broad coverage across the payer landscape.
• AI Automation for Precision and Speed: AI automation enhances coding accuracy and completeness while delivering superior efficiency and operational performance across the entire coding operation.

Performance and Value

• Trusted by leading Medicare Advantage, Medicaid, and ACA health plans for over 45 years.
• 98% annual customer retention rate among health plan clients.
• Fees that are 20% to 40% lower than other vendors' total chart acquisition costs, delivering significant cost savings without sacrificing quality.
• Accurate risk adjustment coding that captures member health complexity and ensures maximum reimbursement for health plans.

Datavant's Risk Adjustment / HCC Coding solution integrates seamlessly with its broader suite of offerings, including health data retrieval, HIM coding, and real-world data ecosystem services. The platform is built to support health plans in making healthcare more accessible, effective, and affordable through smarter data exchange and interoperability, ensuring that every risk adjustment decision is powered by complete and accurate health data.