The risk adjustment tool uses natural language processing and machine learning — two types of artificial intelligence — to help payers increase claim accuracy and address compliance issues. Specifically, it combines analytics, chart retrieval, coding and submission with AI to expedite the coding process for more precise reimbursement.
“Risk adjustment requires a high level of clinical data acquisition and careful analysis of millions of medical records to assign the proper diagnosis code to claims,” Doug Duskin, senior vice president and general manager of clinical review at Change Healthcare, said in a news release.
“Health Fidelity’s [natural language processing] engine has demonstrated very high sensitivity in identifying ICD and [Hierarchical Condition Category] codes, enabling their clients to realize a 20 to 30 percent increase in risk capture,” he added. “This added capability is exciting as we expect it will lead to better gap closure and improved quality of care and outcomes for members.”
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