TL;DR
Review source documentation and proposed HCC findings with clinical and coding oversight. Inspect MEAT documentation and retain the evidence and reviewer history needed for an agreed audit handoff.
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.
Retain encounter and documentation references for reviewed findings.
Record accept, modify, reject, and clarification decisions.
Keep program, service period, payment year, and version context explicit.
Reconcile reviewed output, held work, and acknowledgment evidence.
Security and audit readiness
Keep source records, documentation review, version context, and reviewer decisions together for the agreed audit handoff.
Review proposed findings against current documentation and route unresolved clinical questions to the responsible clinician.
Assign chart readiness, coding review, quality checks, and release responsibilities before expanding the cohort.
Define the cohort, review period, denominators, and exclusions before comparing workflow results.
Everything you need to optimize HCC capture and maximize RAF scores
Compliance & Audit
Requires Monitor, Evaluate, Assess, or Treat evidence before an HCC is accepted for the payment year.
Runs age/sex Medicare Code Editor validation and blocks ICD-10 Excludes1 conflicts before final RAF scoring.
Every captured HCC links source encounter -> ICD-10 -> model version -> hierarchy decision -> reviewer ID.
CMS Submission
Generate files, submit eligible batches, and keep deadline visibility in the same workflow that finalized the HCC capture.
Builds submission-ready files from finalized HCCs, demographics, encounter provenance, and review status.
Submits eligible batches when enabled and records CMS acknowledgment IDs back onto the submission record.
Shows open, upcoming, and closed CMS windows so teams can stage sweeps before deadlines.
Model Coverage
Legacy Medicare Advantage payment-year analysis and back-testing.
Segments produced
Concurrent Medicare Advantage scoring and historical comparison.
Segments produced
Medicare Advantage cohorts using the fully phased-in v28 methodology.
Normalization factor: 1.000 PY26.
Segments produced
End-Stage Renal Disease members, dialysis cohorts, and post-graft reviews.
Segments produced
Part D prescription drug benefit scoring, bid support, and reconciliation.
Segments produced
AI reviews charts and identifies potential HCCs
System maps clinical evidence to support codes
Coders review and confirm compliant diagnoses
Track RAF improvement and audit readiness
Optimize RAF scores across your member population with prospective and retrospective HCC capture.
Ensure accurate risk scoring for quality measurement and shared savings calculations.
Capture HCCs at the point of care with real-time alerts and documentation support.
Establish the program, population, service period, payment year, and supported configuration in the demonstration. Retain that context with each review and export so results from different periods are not treated as interchangeable.
Trace a proposed finding to the source encounter and documentation. Inspect the accept, modify, reject, and clarification workflow, reviewer permissions, and release history. The clinician remains responsible for clinical documentation.
Review eligibility of the selected cohort, held records, authorization to release, and available submission channels. Preserve the released output and acknowledgment evidence, and reconcile exceptions rather than treating file generation as acceptance.
Ask to inspect source references, review decisions, timestamps, version context, and export access on a representative sample. Agree audit-response responsibilities and reporting. Historical captures require current supporting documentation and review; they are not automatic carry-forwards.
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.
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.
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.
Yes — ESRD-HCC v21/v24 and RxHCC v08 are first-class.
Agree the packet contents, source access, reviewer history, export format, and delivery timing during evaluation. No fixed turnaround is promised.
Yes — QuickIntell generates the files and submits when the org-level toggle is on, capturing the CMS acknowledgment ID.
Review all mapped HCCs and the hierarchy decisions with source references and the responsible coding reviewer.
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.
Define the cohort and workflow baseline, then compare review time, unresolved documentation, correction rates, and evidence completeness. No RAF increase or revenue outcome is promised.
The category list your coders and auditors work from, rebuilt from the CMS model software and mappings.
ICD-10-CM mappings, coefficients by segment and hierarchies.
HCC capture pipeline from coding review to validated diagnoses
Clinical-note source for MEAT-ready risk adjustment evidence
MA submission downstream for finalized HCC and RAF output
Consume recapture gaps and protect risk-based revenue
Track RAF KPIs, recapture rate, and revenue impact
Write approved HCC and RAF results back to the EHR
This page covers software your team operates. Risk adjustment coding and documentation review services are a separate engagement with defined review responsibilities, quality checks, customer release authority, and a scoped quote.
Scope your documentation inputs, program context, review responsibilities, and evidence handoff in a product demo.