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
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
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
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
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
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