See the whole chart. Capture every payable HCC.
An AI-powered chart intelligence platform for healthcare risk adjustment and quality. RiskQ360 reads medical records straight from PDFs — no EHR integration required — and turns them into coded, cited, audit-defensible intelligence: every HCC, every RAF dollar, every care gap, each one backed by page-level evidence and a MEAT breakdown. A coder confirms; the system never guesses unsupported.
A dual ML + LLM pipeline reads the chart, finds every legitimate code at the right specificity, proves it with evidence, and quantifies its risk and quality value — with a coder always in control of what ships.
PDF intake with per-page quality scoring and GPT-4o Vision OCR fallback. Network folders, Azure Blob, S3, SharePoint, scanned docs, EHR exports — no integration required.
BioClinicalBERT predicts HCC categories from the full text; TF-IDF retrieves precise ICD-10s across 7,903 codes; GPT-4o verifies each one — catching codes humans and single-model tools miss.
MEAT validation, six-status negation, and page-level evidence spans behind every code. Audit-defensible by construction, RADV-ready on export.
RAF scoring with V28 hierarchy, captured-vs-potential per member, and HEDIS care-gap closure across 100+ measures — risk and quality on one surface.
RiskQ360 doesn't ask a single model to guess codes. It runs a deterministic pipeline that pairs an ML predictor with semantic retrieval, then gates and verifies every candidate before a code is ever called payable.
A multi-label HCC predictor reads the full chart and catches risk patterns the LLM misses in long documents — working on raw text, not just extracted lines.
For each predicted HCC, TF-IDF searches the 7,903-code ICD-10-CM catalog — constrained to the V28-mapped subset — to find the right specificity (E11.65, not E11.9).
ConText/NegEx gating removes negated, historical, and family-history mentions; GPT-4o then verifies clinical support and Monitor / Evaluate / Assess / Treat evidence.
RiskQ360 is PDF-native and deploys inside your environment — on-prem, cloud, or folder-based — with CMS-HCC V28 as the reference anchor.
Risk adjustment and quality on capitated and value-based contracts — for coders, compliance and audit teams, quality analysts, and revenue leaders. Configurable per plan, per line of business, per measurement year.
Read the white paper for the full architecture, or walk through the deck.