The only source of truth for the risk of members: rupture

Your members are more sick than risk scores do not reflect. Not because diagnoses do not exist – they are buried under unstructured data on fragmented systems. Each missing hierarchical category (HCC) has remained unqualled income. Each code not supported is an invitation to the risk of compliance.

Medicare adjustment plans (MA) have accepted this reality for decades: choose between an in -depth examination of graphics and deadlines for respect, between precision and affordability. The retrospective solution of Raapid’s risks completely eliminates these false choices.

Income hidden in your graphics

Studies show that the plans are missing 15 to 20% of legitimate CHCs during the initial coding. These are not rare or complex conditions – these are documented diagnoses that are often lost in suppliers’ notes, specialized consultations and liberation summaries.

The traditional retrospective review promises to find them but provides compromises. Manual examination reaches meticulousness but takes 30 to 40 minutes per table. Coding assisted by the NLP works faster, but with an accuracy of 20 to 30% (more than 12 to 18 months), creating more work than it eliminates. The two force you to choose: a complete review of certain graphics or a superficial review of all the graphics.

Meanwhile, organizations that have modernized their retrospective programs capture codes that you miss, subjecting clean data while you review and keep the margins while costs increase.

Retrospective Raapid Risk Risk Solution – Creation of your single truth source

It is not just a gradual improvement in the old process – it modernizes and replaces it. Our new retrospective clinical AI platform, powered by a neuro-symbolic AI, reasons by clinical documentation such as your best coders, understanding of the context and evaluating evidence. But unlike human examiners, it deals with populations of entire members in the time it takes to manually review dozens of graphics.

The transformation is immediate:

• First day: 92% + accuracy of the box
• Treatment time: Less than 8 minutes per full table
• KING: Delive 10: 1 guaranteed king
• Final precision: 98% with review expert

It’s not about working faster – it’s about working differently.

Find additions, delete unpreined codes

The integrity of income means capturing each legitimate CHC and deleting each code not supported. Most solutions excel in one or the other. The real retrospective excellence requires both.

The RAAPID solution identifies non -claimed income by reasoning by the documentation of other systems are lacking. This specialized note mentioning controlled diabetes? Capture. The liberation summary notes congestive heart failure? Identified. The office visit documenting a major depression? Found and coded.

Simultaneously, the solution validates the code existing against source documentation. No proof in support? Deleted before submission. Doubted documentation? Facred for a human review. Each code submitted has evidence paths based on clear meat.

Your risk scores become precise reflections in the acuity of members – not approximations based on partial data.

60 to 80% productivity Gains changes

When coding teams describe their experience with our solution, they don’t talk about working harder – they describe smarter work.

The graphics previously requiring 30 to 40 minutes to examine are treated in less than 8 minutes. Coders who have already spent days in routine, are now focusing on complex scenarios that require clinical expertise. The teams that previously counted on seasonal entrepreneurs now manage advanced volumes with permanent staff.

Productivity gain is not precipitation – it involves eliminating the examination of unnecessary manual graphics and reworking 80% of the lower automation code.

Your certified coders are becoming clinical consultants, not error corrères. They engage providers on improving documentation, and not on the management of spreadsheets. They guarantee coding excellence, not volume treatment.

Cost reduction of 40% thanks to an architectural change

The reduction in traditional costs implies making choices on what to sacrifice. The Raapid approach means choosing what to automate.

When the retrospective journal reaches 92% accuracy immediately, you completely eliminate the examination cycle of the second pass. A pass. Do. No rework loops, no quality sampling, no repeated corrections. When the graphs are automatically treated at 98% final precision, your team focuses only on the 30% that really benefit from clinical expertise. When the permanent teams manage the high season without overtime, you do not pay for the armies of entrepreneurs.

Savings compound: reduction in labor costs, eliminated retouching, reduces technological redundancy and prevented compliance penalties. Financial directors see foreseeable margins. Coding directors see sustainable operations. Members see specific risk profiles, ensuring appropriate care management.

Mathematics have changed

The trilemma (cost, speed and precision) existed because technology could not correspond to human reasoning. The traditional natural language process (NLP) could correspond to the models, but could not understand the context. Humans could understand the context, but could not evolve.

The neuro-symbolic AI breaks this constraint by reasoning on a large scale. He assesses clinical documentation with an expert level judgment at calculation speed. The impossible becomes standard.

Transition

The plans feeling our solution follow a coherent model. This takes six months in the evaluation – appear suppliers, build a consensus, obtain a budget. Once decided, the transformation accelerates considerably.

Six weeks for proof of concept. No months of pilots. Six weeks validating that the accuracy of 92% + day is real, this 8 -minute treatment works with your graphics and that the final accuracy of 98% is achievable.

Then, the extraordinary part: four weeks of treatment from 150,000 to 200,000 graphics in full production.

Consider this progression. Six months to deliberate. Six weeks of validation. Four weeks transforming your entire retrospective program. While competitors assess suppliers until December, you already treat the volumes of the first quarter.

No disturbance. No stop time. Results just on a large scale and at speed which redefine what is possible.

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This sponsored content was produced by Raapid. The editorial team of Industry Dive was not involved in its creation.