Risk adjustment AI is only as good as the data behind it.
Health Data Max normalizes fragmented claims, charts, and encounter files into a clean, unified foundation — so every insight, submission, and audit is built on data you can trust.
Powered by Agentic AI & Fine-Tuned LLMs
Every Health Data Max solution leverage Agentic AI—a multi-agent intelligence architecture designed to continuously review CMS files, member charts, and claims data. Each product, from chart review to RADV defense, benefits from these agents’ ability to reason, validate, and adapt to changing CMS models.
This ensures unmatched accuracy, auditability, and compliance across your risk adjustment lifecycle.
Delivering real-time clinical intelligence at the chart level
Leverages proprietary NLP and LLMs to scan structured & unstructured data for HCCs and missed coding opportunities.
Assists coders and QA teams with compliant code suggestions, source-linked references, and confidence scoring.
Supports prospective, retrospective, and concurrent chart reviews.
Tracks every action for audit-readiness and traceability (full audit trail).
Seamlessly integrates with your existing EHR or coding platform.
Automated validation and reconciliation across your entire submission pipeline
Ingests and analyses X12 837 I/P/D encounter files.
Monitors TA1, 999, 277CA, MAO-002, MAO-004, MMR, and MOR files for errors and rejection trends.
Real-time dashboards flag rejected or dropped encounters.
Built-in reconciliation tools link rejected claims to charts, ensuring no revenue is lost.
Keeps your plan audit-ready and aligned with CMS requirements.
Automated validation and reconciliation across your entire submission pipeline
Drive more accurate risk scoring and maximize revenue without over-coding
Identifies undocumented HCCs across clinical records using AI.
Prioritizes high-impact, high-chronic patients to close the right gaps first.
Supports prospective programs that improve performance before the look-back ends.
Reduces risk of over- or under-coding by flagging anomalies with contextual evidence.
Generates predictive RAF impact and submission completeness metrics.
Drive more accurate risk scoring and maximize revenue without over-coding
Agentic AI in Healthcare
Transform Risk Adjustment with AI That Actually Works
Cut chart review time by 80% and boost RAF scores helped by AI agents that think, learn, and optimize your entire risk adjustment workflow.
We're revolutionizing healthcare with AI that thinks, learns, and optimizes risk adjustment for better patient outcomes and organizational success.
From identifying missed HCCs to validating encounters before submission, AgentHDM agents turn fragmented workflows into a single, intelligent operating layer — reducing rework, improving accuracy, and strengthening compliance.
Each AgentHDM agent is engineered as a purpose-specific decision system — not a generic AI assistant. While agents share a common intelligence layer, their capabilities are tightly scoped to the function they perform, ensuring consistent behavior across analytics, chart review, and submission workflows.
Agents combine deterministic logic (CMS guidance, HCC hierarchies, and submission rules) with statistical models trained on historical claims, encounters, and chart data. This hybrid approach allows the system to produce explainable outputs — showing what was identified, how it was evaluated, and which evidence supports the result.
Rather than acting autonomously on source systems, agents generate structured, traceable outputs designed for downstream use by analysts, coders, and operations teams — enabling review, validation, and confident execution at scale.
AgentHDM agents connect chart review, analytics, and submission into one intelligent operating layer — reducing rework, improving accuracy, and strengthening compliance.
Each agent is purpose-built, not generic. Shared intelligence ensures consistency, while tightly scoped roles keep behavior predictable across workflows.
By combining CMS rules and HCC logic with models trained on historical data, agents deliver explainable, evidence-backed outputs — showing what was found, why it matters, and how it was validated.
Outputs are structured for human review, enabling analysts and coders to act with confidence — not blind automation.
AI-powered chart reviews using your historical Medicare Advantage data run up to 80% faster by auto-summarizing clinical evidence, flagging suspected HCC gaps, and pre-building reviewer-ready findings. Reviewers spend less time searching across claims and encounters and more time validating what matters—driving faster throughput, recapture, and submissions without compromising compliance.
AI chart reviews achieve 98% accuracy through cross-validation against Medicare Advantage history. Each diagnosis is validated with MEAT evidence and checked for consistency across prior claims, encounters, and MAO-004/MMR/MOR signals, reducing false positives and rework. Clear, traceable rationales ensure consistent decisions, cleaner coding, and stronger RADV readiness.
Always-on AI chart review processing runs 24/7, including nights and weekends. As charts arrive, the system continuously triages, prioritizes, and routes evidence-backed opportunities with next-best actions. Teams start each day with the highest-impact work already queued—no downtime, no backlog spikes, just continuous progress toward compliant risk capture.
Our autonomous agents work together to revolutionize every step of your risk adjustment process
AI automatically processes medical records, EMR data, and claims across all formats. No manual data entry required.
Advanced NLP identifies HCC opportunities with 99.8% accuracy. Our AI learns from every interaction to improve continuously.
Built-in RADV audit protection ensures every code meets CMS requirements. Automated compliance checking prevents costly errors.
Streamlined submission process with real-time tracking. Get paid faster with error-free claims and comprehensive audit trails.
Complete AI-Powered Solutions
Everything you need for end-to-end risk adjustment automation
Powered by Agentic AI, Health Data Max connects every function—analytics, documentation, validation, and audit—through one autonomous, governed system
Powered by Agentic AI, Health Data Max connects every function—analytics, documentation, validation, and audit—through one autonomous, governed system
Powered by Agentic AI, Health Data Max connects every function—analytics, documentation, validation, and audit—through one autonomous, governed system
Detects missing, miscoded, and unsorted HCCs
97.2% accuracy
Identifies high-value members & next-best actions
98.5% accuracy
Chart extraction + MEAT → HCC detection
120 opportunities
Validates encounter submissions end-to-end
95.5% accuracy
Agentic AI in Healthcare
Transform Risk Adjustment with AI That Actually Works
Cut chart review time by 80% and boost RAF scores with autonomous AI agents that think, learn, and optimize your entire risk adjustment workflow.
Our autonomous agents work together to revolutionize every step of your risk adjustment process
AI ingests records and claims—no manual work
NLP identifies HCCs with 99.8% accuracy
RADV-ready compliance checks built in
Faster, cleaner submissions with full audit trails
