3-Pillar Value Proposition

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.

Chart AI Copilot 

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.

Our Impact

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.

80%

Time reduction

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.

98%

Validation accuracy

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.

24/7

AI processing

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.

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