Under-coding in Risk Adjustment data

How do we solve this problem?

HiLabs offers a proactive approach to detect data errors corresponding to under-coding using a combination of Medical Ontologies and historical data as input in the AI engine. The AI engine also called MCode has been built on 30+ million member's records from CMS data and analyzes every possible slice of information. It also gives the client the flexibility to customize according to the health plans needs and provides the client with auditable facts.

Eliminates the need for 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.

Auto learning of billing patterns

AI-based Analysis on every possible slice of data is possible and eliminates the need of deterministic checklists based on medical charts. It also identifies errors unknown to the user.

Your analysis is no longer limited to your own data

Our solution comes with an out-of-the-box knowledge base of 2 billion plus HCC coding patterns from the entire Medicare U.S FFS population.

Supervised and Unsupervised training

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High ROI

The tool enables organizations with Medicare risk-based contracts to achieve higher revenue goals without a significant investment of resources. MCode does not require medical charts to detect anomalies which is often required by other solutions in the market.

Easy data ingestion with insured security

We provide quick data ingestion with our MGest platform. Our technology is also compatible with most of the data source systems in the industry. HiLabs is HIPAA compliant and insured through virtual or cloud systems. In addition, our proof of concept does not require PHI information and generally takes 6-8 weeks.

Let’s Uncover Hidden Savings Opportunities

We at HiLabs are helping the largest payers in the country identify new and hidden savings opportunities that reduce data errors and operational costs. With decades of experience in the payer market, we are ready to bring about the change the healthcare industry so desperately needs..


About HiLabs, A cohort of experienced Engineers, Data Scientists and Physicians.

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