Risk Management
Support accurate diagnosis documentation and risk adjustment, and stay RADV-ready — helping your organization accurately reflect each patient's documented complexity.
The Challenge
Underdocumented diagnoses mean underpayment. For every HCC code that goes uncaptured, Medicare Advantage and risk-adjusted programs pay less than the patient's true complexity warrants. Meanwhile, RADV audits find unsupported codes that trigger repayment demands. The result: you're leaving documented complexity unrecognized while simultaneously carrying audit risk — a problem that only worsens as your MA panel grows.
Five Core Capabilities
Scans every patient's clinical record daily against HCC v24 and v28 code sets — surfacing undocumented diagnoses with supporting clinical evidence, so coders and providers close gaps before the submission window closes.
Projects each patient's expected RAF score versus current documented score — quantifying the impact of each gap and prioritizing outreach to patients where documentation improvement has the highest clinical and quality impact.
Real-time feedback to providers at the point of documentation — suggesting more specific HCC-relevant codes when clinical evidence supports them, improving accuracy without adding documentation burden.
Maintains continuous audit-ready documentation for every submitted HCC code — mapping each diagnosis to supporting clinical evidence, encounter records, and provider signatures to withstand CMS scrutiny.
Projects total risk-adjusted premium value by payer and contract — enabling leadership to plan for shared savings, capitation changes, and benchmark adjustments with confidence.
Programs Supported
ROI: 10-Provider Clinic
| Metric | Before Unity | After Unity |
|---|---|---|
| HCC Capture Rate | 72% | 92% ↑ |
| Average RAF Score | 1.21 | 1.42 ↑ |
| Risk-Adj. Value | $1.8M | $2.1M ↑ |
| RADV Readiness | Manual | 98% ↑ |
Explore Other Modules
All eight modules share the same AI engine, patient data, and action pipeline.
Capture the value your
patients' complexity earned.
We'll show you exactly how many HCC gaps your organization currently has — and what they're worth.
Built for HIPAA · Aligned with SOC 2-type controls · FHIR R4 Ready · ROI in 90 Days