Lift RAF +0.15–0.30 and automate HCC capture for MA, ACA, and ACO populations — 30 days to first measurable lift, audit-ready from day one.
Optimize risk capture & RAF accuracy without manual chart-chasing
Risk Adjustment Technology lets clinical and RCM teams surface suspect conditions, code HCCs accurately, and optimize RAF in days—not months—so you increase compliant revenue and cut review costs.
99.2% audit pass methodology: CMS RADV and plan audits, n=2,800 charts sampled, 2024–2025.
+0.15–0.30 RAF lift per eligible member • ↓40–60% manual review time • ↑30–45% more supported HCCs captured • 62% productivity lift
The Problem
You're stuck with spreadsheet-driven reviews, missed HCC opportunities, and retro audits that arrive too late.
It costs weeks of coder time, avoidable revenue leakage, and compliance risk when documentation doesn't fully support HCCs.
Here's the Simple Way
Risk Adjustment Technology uses AI-driven suspecting, chart understanding, and coder-in-the-loop guidance to capture risk accurately the first time. Built for payors and for providers, it pulls validated ICD-10 sets from QuickCode, feeds finalized RAF to Claims, and keeps recapture analytics in Analytics tied to evidence citations so you raise RAF while staying audit-ready.
Built for v28
CMS-HCC v28 is here. Most teams are losing 3.1–3.7% RAF.
QuickIntell keeps the phase-in math, model mapping, and audit trail aligned for every payment year so RAF movement does not disappear inside spreadsheets.
PY2024
CMS-HCCPY2025
CMS-HCCPY2026
CMS-HCCFully transitioned to v28
The rules engine applies the right model every time
- Auto-selects the correct CMS-HCC v24/v28 blend by payment year and locks the model version on every RAF job.
- Applies the right normalization factor before scores flow to analytics, submissions, and EHR write-back.
- Handles dual-mapped ICD-10 codes in the crosswalk, including E11.22, so both diabetes and CKD HCC impacts stay visible.
- Shows hierarchy suppression and v22/v24/v28 comparison before coder sign-off, with the trace preserved for audit.
How It Works
Get started with Risk Adjustment Technology in four simple steps
Connect
Securely plug into your EHR, data warehouse, and claims feeds (FHIR/HL7, 837/835/270/271), while QuickIntell pulls validated ICD-10 sets from QuickCode.
Configure
Choose models by line of business (MA, ACA, CMS, commercial), specialties, and documentation thresholds.
Run
The engine flags suspects, validates evidence, recommends HCCs, and feeds finalized RAF to Claims in real time.
HCC Crosswalk Viewer
Explain every ICD-10 to HCC decision before sign-off
Coders can search a code such as E11.22, compare cross-version mappings across v22, v24, and v28, review hierarchy and coefficient context, then use the Compare Models toggle and trace results to explain why a code did or did not capture.
ICD-10 search
Search by diagnosis code or HCC category, then open the related mapping without spreadsheet lookups.
Cross-version mapping
Compare CMS-HCC v22, v24, and v28 behavior before a coder accepts the HCC impact.
Hierarchy diagram
See which HCCs suppress the selected category and which lower categories it suppresses.
Trace flow
Open the trace for non-capturing codes to see age and sex validation, model validity, and hierarchy suppression.
HCC Crosswalk Viewer
Risk Adjustment / Crosswalk
Hierarchy diagram
Trace flow for non-capturing codes
Headline Metrics
Real results from organizations using Risk Adjustment Technology
RAF Lift (MA)
Mean RAF lift (median +0.20; IQR +0.14 to +0.30) across 212,840 MA lives over 2 quarters
RAF Lift (ACA)
Mean RAF lift (median +0.10; IQR +0.07 to +0.16) across 131,500 members
Supported HCC Capture
Delta (range +28–51%) vs. customer baseline
Coder Productivity
Charts/hour (from 8.1 → 13.1), TAT ↓47% (72h → 38h)
Query Closure
Faster physician query closure (5.3 days → 3.5 days)
Audit Pass Rate
External audit pass rate; CMS RADV and plan audits, n=2,800 charts sampled, 2024–2025; 0.7% net adjustments (prev. 2.6%)
Financial Impact
Incremental Revenue (MA)
12-mo modeled ROI 6.2× (range 3.9–8.4×); equivalent to $1.4M–$2.6M annualized for a 5,000-life MA panel (industry estimates cite ~$1,800/patient/year unrecaptured)
Time-to-First Value
First suspect list; measurable lift in 28–42 days
Feature Groups
Comprehensive capabilities that power your risk adjustment workflow
Automate
- AI suspecting & gap detection trained on 20M+ patient records (MA & ACA tuned).
- Evidence extraction from notes, labs, imaging, and problem lists with traceable citations.
Collaborate
- Coder-in-the-loop workflows with queue triage, second-level review, and physician queries.
- Role-aware tasks for risk, coding, and care teams to resolve gaps before the claim.
Control
- Program-specific rulesets (CMS, MA, ACA) with editable thresholds & exclusions.
- Policy guardrails prevent upcoding and ensure documentation sufficiency before submission.
Report
- Real-time RAF & HCC analytics by member, provider, clinic, and line of business.
- Audit-ready trails: who coded what, when, and why—with evidence snapshots.
Recapture-Rate Optimization
Move from a 70-75% baseline to 90%+ achievable recapture
Recapture Gaps shows chronic HCCs captured last year but missing this year, ranks them by RAF impact, and turns the highest-value opportunities into care-team outreach tasks.
Baseline recapture
Typical chronic HCC recapture before a focused sweep.
Achievable target
Risk teams can reach higher capture when gaps are worked weekly.
Nudge threshold
The dashboard flags programs below the weekly threshold.
Recapture Gaps
Year = Current / Patient Population = MA
Recapture Rate YoY
84%
Target 90%+
CMS Submission Packaging
Generate CMS-ready packages only after HCC review is complete
Submission packaging helps MA operations preview the cohort, exclude charts without human review by default, generate RAPS or EDPS files, and preserve the CMS acknowledgment trail needed for audit response.
- RAPS/EDPS file generation from finalized HCC captures with reviewed evidence attached.
- Quarterly window guardrails that preview the current submission window and keep late batches from being sent.
- CMS acknowledgment-ID tracking so operations can tie every package to the returned CMS receipt.
New Submission Batch
Plan = Medicare Advantage / Window = current quarter
Submission Window
Current quarter
Review Gate
Unreviewed excluded
Audit Link
Evidence retained
Package preview
1,284 members / unreviewed charts excluded by default
Integrations
Works with: Epic, Cerner, eClinicalWorks, Athenahealth, MEDITECH, OpenEMR; Availity, Waystar, Change/Optum iEDI, STEDI; Snowflake, Redshift, BigQuery; SSO (Okta, Azure AD). Connects to 3,500+ payors via Availity, Waystar, Change/Optum, and STEDI clearinghouse networks.
Supported EHRs
Clearinghouse & Payer Systems
Data Clouds
SSO Providers
What It Enables:
EHR (FHIR/HL7)
Ingest encounters, problems, meds; write back codified HCCs & notes.
Clearinghouse
Reconcile 837/835 with risk capture outcomes; automate follow-ups.
Data clouds
Run cohort-level RAF simulations; share governed datasets for actuaries.
SSO
Least-privilege access, enterprise provisioning, and audit compliance.
Security & Compliance
Enterprise-grade security and compliance built into every aspect of our platform
Encryption
Data encrypted in transit (TLS 1.2+) & at rest (AES-256), field-level tokenization for PHI.
Identity
SSO/SAML/OIDC, MFA, SCIM provisioning, role-based access with least privilege.
Governance
HIPAA & SOC 2 Type II controls, audit logs, immutable evidence snapshots, BAA available.
Deployment
HIPAA-eligible cloud or customer VPC; data residency controls.
Compliant & BAA
Type II
In progress
Uptime SLA
Pricing
Choose the plan that fits your organization's needs. All plans include core suspecting and RAF optimization.
For single clinics / pilot MA panels.
or $0.05 PMPM (whichever is higher)
- Up to 25k members or 50 providers
- Core suspecting, coder queue, RAF dashboard
- Email support, baseline reports
For multi-site groups & regional plans.
or $0.04 PMPM
- Up to 250k members; advanced analytics & provider scorecards
- Physician query workflow; EHR write-back
- SLA support, SSO/MFA, sandbox + UAT
For national plans & IDNs.
/ enterprise pricing
- Unlimited members; multi-LOB (MA, ACA, commercial)
- Custom rulesets, model tuning, dedicated CSM
- Dedicated VPC deployment, VPC peering
PMPM = per member per month. Volume discounts available.
Frequently Asked Questions
Everything you need to know about Risk Adjustment Technology
Need implementation details? Read the full risk adjustment FAQ.
Ready to capture risk accurately and compliantly?
See how healthcare organizations use Risk Adjustment Technology to optimize RAF accuracy, reduce review costs, and increase compliant revenue.