Retrospective reviews play a valuable role in effective risk adjustment operations, but retrospective reviews often occur months after an encounter has taken place, if not longer. The more time that passes, the greater your odds of missing risk-adjustable opportunities due to gaps in documentation. These gaps impact reimbursement and compliance, and they make it more difficult for provider organizations to deliver on population health initiatives.
Edifecs Post-Visit Review leverages AI and NLP to analyze all available clinical data and quickly reconcile it with Hierarchal Condition Category (HCC) codes on the claim. With our SaaS-based solution, administrative teams can add HCCs with supporting clinical documentation, or remove codes for patient conditions that are resolved or lack the clinical data to substantiate them.
Enable Program Compliance
Edifecs helps organizations maximize care funding through complete and accurate coding.
Reduce organizational dependence on retrospective reviews.
Identify supported diagnoses with AI analysis of structured and unstructured chart data.
Manage all your risk-based contracts through one uniform workflow.
