HCC Coding & Risk Adjustment Software
TL;DR
- Captures every compliant HCC across v22/v24/v28/ESRD/RxHCC.
- Submits RAPS/EDPS to CMS and assembles RADV packets in <24h.
- Lifts recapture rate from 70-75% to 90%+ — ~$1,800/patient/year recovered.
Recover ~$1,800 per Medicare Advantage member per year. AI captures every compliant HCC across v22/v24/v28 plus ESRD, validates MEAT documentation, and assembles RADV-ready audit packets in under 24 hours.
QuickCode supplies the HCC capture pipeline, QuickScribe provides the clinical-note source, Claims carries MA submission data downstream, Revenue Integrity consumes recapture gaps, Analytics monitors RAF KPIs, and QuickEHR writes approved risk data back to the EHR.
Typical HCC revenue leakage for each Medicare Advantage member.
Compliant recapture benchmark vs. 70-75% industry performance.
Audit packet assembly time vs. 2-3 weeks of manual work.
Daily coder throughput target vs. 18-25 charts manually.
Security and audit readiness
Why Choose QuickIntell for Risk Adjustment?
RADV Packet in <24 hr
Assemble chart evidence, ICD-10 mappings, MEAT validation, hierarchy decisions, and reviewer trail into audit-ready packets within 24 hours.
90%+ Recapture Rate
Move from typical 70-75% performance toward a 90%+ achievable benchmark with AI-surfaced chronic condition gaps.
2x Coder Throughput (40-50/day)
Automate crosswalk lookups, model selection, and hierarchy rules so coders can review 40-50 charts per day instead of 18-25.
$1.4M-$2.6M on a 5K MA Panel
For a 5,000-life Medicare Advantage panel, closing compliant HCC gaps can unlock $1.4M-$2.6M in annualized incremental revenue.
Complete Risk Adjustment Features
Everything you need to optimize HCC capture and maximize RAF scores
HCC Identification
- AI chart review & analysis
- Suspect condition alerts
- Diagnosis recapture prompts
- Clinical evidence mapping
Coding Support
- HCC code suggestions
- Specificity recommendations
- V24/V28 model support
- Hierarchy optimization
Compliance & Audit
- Documentation validation
- Audit trail & evidence
- RADV preparation tools
- Coder query workflows
Analytics & Reporting
- RAF score dashboards
- Provider scorecards
- Trend analysis reports
- Financial impact metrics
Compliance & Audit
Controls that keep HCC capture defensible
MEAT Documentation Validation
Requires Monitor, Evaluate, Assess, or Treat evidence before an HCC is accepted for the payment year.
MCE and Excludes1 Checks
Runs age/sex Medicare Code Editor validation and blocks ICD-10 Excludes1 conflicts before final RAF scoring.
RADV-Ready Audit Chain
Every captured HCC links source encounter -> ICD-10 -> model version -> hierarchy decision -> reviewer ID.
CMS Submission
Submission workflows stay attached to the score
Generate files, submit eligible batches, and keep deadline visibility in the same workflow that finalized the HCC capture.
RAPS/EDPS File Generation
Builds submission-ready files from finalized HCCs, demographics, encounter provenance, and review status.
Direct CMS Submission
Submits eligible batches when enabled and records CMS acknowledgment IDs back onto the submission record.
Submission-Window Calendar
Shows open, upcoming, and closed CMS windows so teams can stage sweeps before deadlines.
Model Coverage
CMS models covered across MA, ESRD, and Part D
CMS-HCC v22
Legacy Medicare Advantage payment-year analysis and back-testing.
Segments produced
CMS-HCC v24
Concurrent Medicare Advantage scoring and historical comparison.
Segments produced
CMS-HCC v28
Medicare Advantage cohorts using the fully phased-in v28 methodology.
Normalization factor: 1.000 PY26.
Segments produced
ESRD-HCC v21/v24
End-Stage Renal Disease members, dialysis cohorts, and post-graft reviews.
Segments produced
RxHCC v08
Part D prescription drug benefit scoring, bid support, and reconciliation.
Segments produced
How Risk Adjustment Works
Analyze
AI reviews charts and identifies potential HCCs
Validate
System maps clinical evidence to support codes
Capture
Coders review and confirm compliant diagnoses
Monitor
Track RAF improvement and audit readiness
Who Uses QuickIntell Risk Adjustment?
Medicare Advantage Plans
Optimize RAF scores across your member population with prospective and retrospective HCC capture.
ACOs & Value-Based Care
Ensure accurate risk scoring for quality measurement and shared savings calculations.
Provider Organizations
Capture HCCs at the point of care with real-time alerts and documentation support.
Vendor Comparison
Why QuickIntell vs alternatives
| Capability | QuickIntell | Spreadsheets | Generic AI Coding Tools | Legacy Retrospective Vendors |
|---|---|---|---|---|
| Model coverage | CMS-HCC v22/v24/v28, ESRD-HCC v21/v24, RxHCC v08 | Manual tabs and version drift | Prompt-dependent model support | Usually tied to one retrospective program |
| Real-time vs retrospective | Prospective prompts plus retrospective sweeps | After-the-fact reconciliation | Detached from live chart workflows | Primarily retrospective chart review |
| Dual-mapped ICD-10 | Crosswalk traces every mapped HCC | Easy to miss secondary mappings | Requires manual verification | Often returned as coder notes |
| MEAT validation | Evidence gate before HCC acceptance | Manual reviewer judgment | Narrative suggestion only | Separate QA review cycle |
| RAPS/EDPS submission | File generation, direct submission, acknowledgment IDs | Export prep outside the sheet | No native submission workflow | Batch handoff after review |
| RADV packet turnaround | Source-to-reviewer chain assembled in under 24 hours | Manual evidence chase | No durable audit packet | Days to weeks of binder assembly |
| Provider CDI workflow | One-click clarification and care-team routing | Email or task list follow-up | Copy/paste query drafting | Late provider outreach |
Frequently Asked Questions
How does AI identify missed HCCs?
QuickIntell analyzes clinical documentation, lab results, medication lists, and historical claims to identify conditions that may qualify as HCCs. The AI surfaces these opportunities with supporting evidence for coder review.
Does this work with both V24 and V28 models?
Yes! We fully support the V28 model, which reached 100% implementation in 2026. Our system also retains V24 model support for historical analysis and calculates RAF scores under both models, highlighting coding differences.
How do you ensure compliance?
Every HCC suggestion includes the clinical evidence required for compliant coding. Our system validates that documentation supports the specificity level coded and maintains complete audit trails for RADV.
Do you support ESRD and RxHCC models?
Yes — ESRD-HCC v21/v24 and RxHCC v08 are first-class.
How fast can you assemble a RADV audit packet?
Under 24 hours, with full evidence chain per HCC.
Can the system submit RAPS/EDPS files directly to CMS?
Yes — QuickIntell generates the files and submits when the org-level toggle is on, capturing the CMS acknowledgment ID.
How does QuickIntell handle dual-mapped ICD-10 codes (e.g., E11.22)?
We capture all mapped HCCs simultaneously and apply hierarchy correctly — spreadsheets miss the second mapping.
Can this integrate with our EMR?
Yes! QuickIntell integrates with Epic, Oracle Health (formerly Cerner), athenahealth, eClinicalWorks, OpenEMR, NextGen, and Allscripts/Veradigm to access clinical data and surface HCC opportunities in real-time during documentation.
What's the typical ROI?
Most customers see 15-20% improvement in RAF scores within 6-12 months, translating to $50-150 additional revenue per member per month for Medicare Advantage populations.
Related Products
AI Medical Coding
HCC capture pipeline from coding review to validated diagnoses
AI Medical Scribe
Clinical-note source for MEAT-ready risk adjustment evidence
Claims Filing
MA submission downstream for finalized HCC and RAF output
Revenue Integrity
Consume recapture gaps and protect risk-based revenue
Analytics
Track RAF KPIs, recapture rate, and revenue impact
QuickEHR
Write approved HCC and RAF results back to the EHR
Ready to Optimize Your RAF Scores?
Join healthcare organizations improving HCC capture rates by 15-20% with QuickIntell.