Risk Adjustment
Accurate risk, documented with evidence — not guesswork.
Compare current and projected HCC profiles, trend RAF, review documentation completeness, and prepare for RADV — with suspected opportunities always routed to human review.
The challenge
Why HCC & Risk Adjustment
- Chronic conditions go undocumented year over year.
- Coding reviews are manual and inconsistent.
- Audit preparation is reactive and costly.
Guardrail: Suspected conditions are labeled 'Requires review' and are never presented as confirmed diagnoses.
Average RAF — current vs projected (suspected conditions require review)
Current 0.892 → projected 1.084
Capabilities
What's included
Current vs projected HCC
See which conditions are captured and which need review.
RAF analysis & trending
Member and provider-level RAF over time.
HCC V28 modeling architecture
Model-version aware mapping layer designed for V24→V28 transition.
Diagnosis evidence
Each suspected HCC links to supporting labs, meds, or notes.
RADV audit preparation
Evidence packets and documentation completeness checks.
Financial impact scenarios
What-if modeling with transparent, editable assumptions.
Workflow
How it works
- 01
Map diagnoses to HCCs
- 02
Detect suspected gaps
- 03
Attach evidence
- 04
Coder / clinician review
- 05
Documented outcome
Experience TheFlashAI
Explore the interactive demo with synthetic data, or talk to our team about your organization.