Converged Record Review

Converged Record Review is a medical record review software designed to enhance the efficiency and accuracy of health plan reviews. It empowers medical record reviewers to work more effectively, ensuring accurate reimbursement for health plans. By utilizing artificial intelligence, this software streamlines the review process, helping teams achieve better results while staying compliant with regulatory requirements.

The software simplifies the medical record review process by addressing common challenges such as competing priorities and inefficient systems that can lead to inaccurate diagnosis coding. It enhances hierarchical condition category (HCC) capture, highlighting conditions that require additional attention, thereby saving time on each review.

Key Features and Benefits

• Improved HCC Capture: Highlights conditions needing extra attention, saving time on reviews.
• Better Project Management: Provides clear visibility into reviewer productivity and streamlines project assignments.
• Decreased Regulatory Audit Risk: Utilizes natural language processing (NLP) to minimize false positives and reduce non-compliance risks.
• Reduced Manual Workload: Lowers false positive rates and decreases the need for costly manual chart reviews.

The software offers up to a 50% reduction in false positive identification and a 25% reduction in manual reviews, leading to a 25% decrease in medical record review spending. It focuses on eliminating low-value reviews, allowing coders to concentrate on records that significantly impact risk adjustment outcomes.

Converged Record Review enables teams to quickly identify medical records with valid documentation, reducing efforts on low-impact records. It allows for bulk export of results with highlights and abstracted codes, enhancing decision-making with risk-adjustable findings for submissions in real-time.

Testimonials from users highlight the forward-thinking approach and quality of Inovalon's technology, distinguishing it from other solutions in the market.