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Emed HCC

AI-powered Hierarchical Condition Category coding - fully compliant with V24 & V28 models - maximizing RAF scores for Health Plans and Providers.

1.45 RAF Score
+38% Revenue Lift
V28 Compliant
95% Capture Rate
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V28

HCC Model Compliant

95%

RAF Capture Accuracy

40%

Revenue Lift Avg.

3

Review Types Supported

HCC Performance Analytics

Real-world outcomes from Emed HCC deployments across 50+ health plan and provider organizations.

Emedlogix · Emed HCC — HCC Risk Adjustment Platform
Emedlogix Emed HCC Dashboard - HCC Risk Adjustment Analytics

▪ Average RAF Score Achieved

0.00 RAF Score 0.5 2.0
Before1.05
→
After1.45
+38% Average Revenue Lift

▪ HCC Capture Rates by Review Type

Prospective
92%
Retrospective
95%
Concurrent
89%
HEDIS
87%

* Based on avg. across 50+ health plan deployments (2023-2024)

▪ Revenue Impact Metrics

$0 Avg. per-member revenue increase
0 HCC codes captured annually
0 Weeks to full RAF optimization
0 Clinical records trained on

Health Plans

Comprehensive HCC risk coding solutions tailored for Medicare Advantage and commercial health plan organizations.

Prospective Coding

Identify and close coding gaps before the patient encounter using predictive analytics and prior-year claims data - ensuring full coverage of chronic condition documentation.

  • Pre-visit gap identification
  • AI-suggested diagnoses for clinical review
  • Real-time RAF score modeling
  • Physician alert integrations

Retrospective Chart Review

Systematic review of historical medical records to capture missed HCC codes and recapture unreported conditions - with complete audit trail documentation for every finding.

  • Automated chart pulling & prioritization
  • NLP extraction from unstructured notes
  • Coder review workflow integration
  • Compliance-ready addendum support

Concurrent Coding

Real-time code suggestions delivered during active patient encounters - giving clinicians immediate, encounter-point coding support without disrupting the workflow.

  • EHR-embedded code suggestions
  • Clinical decision support at point of care
  • Instant RAF impact visibility
  • Specialist-specific rule sets

HEDIS Measure Support

Automated HEDIS data capture and gap closure workflows aligned with NCQA specifications - improving Star Ratings and quality-linked revenue for health plans.

  • 90+ HEDIS measures mapped
  • Automated supplemental data submissions
  • Star Rating opportunity identification
  • Member outreach recommendations

CMS-HCC Model Support

Emed HCC is current with the latest CMS risk adjustment model updates - protecting revenue through every regulatory transition.

V24

Legacy model - fully maintained for historical reviews and retrospective audits

V28

Current CMS model - primary prospective and concurrent coding engine

Dual

Simultaneous V24 + V28 side-by-side analysis for transition period compliance

Provider-Side HCC Solutions

Tailored HCC coding tools built for provider organizations operating under value-based contracts.

Value-Based Care (VBCs)

End-to-end HCC capture for providers in value-based contracts - aligning clinical documentation with financial performance targets and risk-sharing obligations.

Accountable Care Organizations

Network-wide risk adjustment tools for ACOs - enabling coordinated capture across primary care, specialists, and affiliated providers under shared savings programs.

Independent Practice Associations

Scalable HCC coding for IPAs managing large delegated networks - with centralized oversight, payer-specific reporting, and audit-ready documentation.

Maximize Your RAF Score Capture

See how Emed HCC can close coding gaps and boost revenue for your health plan or provider organization.

#HCC V28 #RAF Score #Prospective #Retrospective #HEDIS
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