Coders are accurate but slow and can't review every chart. Single-model AI is fast but hallucinates codes, misses specificity, and produces nothing an auditor can trace. And most tools need an EHR integration before they see a single page.
PDF intake with quality scoring and GPT-4o Vision OCR fallback — any source, no integration.
BioClinicalBERT + TF-IDF surface candidate HCCs and precise ICD-10s from the full text.
NegEx gating + GPT-4o MEAT check confirms support and removes negated mentions.
V28 HCC mapping, hierarchy, and RAF — plus HEDIS gaps and suspicion signals.
Coder Accepts / Rejects / Modifies; every action cited and audit-logged.
A multi-label HCC predictor works on raw text and catches risk patterns the LLM misses across 40 pages.
Searches the 7,903-code ICD-10-CM catalog, constrained to the V28-mapped subset for each predicted HCC.
Deterministic negation gating, then GPT-4o checks clinical support and Monitor / Evaluate / Assess / Treat.
Per-page quality scoring with GPT-4o Vision OCR fallback for scanned pages.
Demographics, clinical sentences, risk dx, HEDIS evidence, encounters — in parallel.
BioClinicalBERT predicts HCC categories from the full chart text.
TF-IDF retrieves precise ICD-10s for each predicted HCC.
ConText/NegEx assigns one of six polarities and filters non-payable mentions.
GPT-4o verifies support and extracts Monitor / Evaluate / Assess / Treat.
V28 mapping, hierarchy suppression, and RAF per encounter & member-year.
Payable HCC Pack, HEDIS Pack & Audit Pack for one-click confirm.
Member · 4 payable HCCs · 1 suppressed by hierarchy · captured-vs-potential tracked
Payable HCCs with supported ICD-10s, RAF weights and hierarchy explanations.
Monitor / Evaluate / Assess / Treat per code, with the supporting quote.
Page-level evidence spans traced to source; full-text search across the chart.
ML, LLM and combined confidence per code; negation polarity shown.
Undercoded conditions surfaced from labs, vitals, meds and diagnoses.
Eligibility, numerator and open care gaps across 100+ measures.
Accept / Reject / Add / Delete / Modify — every action timestamped.
RADV-ready package per member, population RAF dashboards, and coder performance over time.
Watch RiskQ360 work the chart end-to-end — from PDF to a coder-confirmed, cited HCC 18.
28 pages scored; 3 scanned pages routed to GPT-4o Vision OCR.
Five pipelines pull demographics, sentences, diagnoses, HEDIS evidence & encounters.
BioClinicalBERT flags diabetes-with-complications from the full text.
TF-IDF returns E11.65 over the generic E11.9.
NegEx keeps the active mention; drops a "family history of diabetes" line.
GPT-4o confirms support: A1C monitored, metformin + glipizide treated.
E11.65 → HCC 18, RAF 0.302; HCC 19 suppressed by hierarchy.
One-click Accept with the page-3 evidence in view; logged for audit.
RiskQ360 serves Medicare Advantage, Medicaid MCOs and ACA plans — for coders, compliance and audit teams, quality analysts, and revenue leaders working capitated and value-based contracts.
Prospective & retrospective HCC capture with V28 hierarchy and RAF scoring.
Page-level citations and MEAT make every code defensible and export-ready.
Chart-based HEDIS across 100+ measures — COL, CCS, BCS, CBP, TRC and more.
Undercoded conditions surfaced from labs, vitals, meds and diagnoses.
Captured-vs-potential RAF, ranked by dollar impact, with recapture tracking.
A coder is always in control of what ships — automation expands only as confidence is proven.
RiskQ360 pre-codes and cites; coders confirm every code. Pure decision support.
High-confidence codes batched for fast Accept; low-confidence flagged for deeper review.
RAF dashboards, suspicion signals & recapture run across the whole membership.
Gap closure & audit packs feed back into plan operations.Human-confirmed
AI pre-codes; a certified coder Accepts / Rejects / Modifies. No code submitted without a human decision.
No ungrounded codes. Every ICD, HCC and HEDIS item links to the exact page and span that supports it.
Every action — who, what, when, before/after — recorded for RADV response and internal review.
Deploys inside your environment so PHI never leaves; sensitive fields access-controlled and governed.
Deterministic clinical logic ensures only active, MEAT-supported conditions are coded payable.
Feature flags, thresholds and prompt templates controlled per plan — and audit-logged on every change.
It reads charts straight from PDFs, codes at the right specificity with a dual ML + LLM pipeline, proves every code with MEAT and page-level evidence, and keeps a coder in control — so you capture what you're owed and defend it on audit.
Let's code a chart together →