MCode

What is its unique value proposition?

The AI engine MCode, has been built on 30+ M members record from CMS data. It analyzes every possible slice of data and gives the client the flexibility to customize according to the health plans need and data. If you think this is not enough, it also provides the client with auditable facts.

Eliminates the need for current rule based approach

Health plans currently work on deterministic checklists when submitting the claims data. They compare against historical Hierarchical Condition Categories (HCCs) benchmarks to review the data of members with risk score in top 20 percentile mark

Auto learning of billing patterns

AI-based Analysis on every possible slice of data thus eliminating the need of deterministic checklists based on medical charts. It also shows errors which are unknown to the user

Your analysis is no longer limited to your own data!

Our solution comes with out-of-the-box knowledge base of 2 billion plus HCC coding patterns of the entire Medicare FFS population of the country

Supervised and Unsupervised training

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High ROI

The tool enables organizations with Medicare risk-based contracts to achieve significantly higher revenue without significant increase in their investment of resources.
MCode does not require medical charts to detect anomalies as required by the existing solutions in the market

Automating the manual processes

Existing solutions in the market are primarily focused on review of medical charts via improved manual review or advanced analytics such as Natural Language Processing

Expanding the review to the entire population

In-house review at organizations with Medicare risk-based contracts includes a small fraction which is 20% or less of the universe of medical charts.
MCode analyzes the entire population


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