HEDIS Audit Management ICD Engine

Delivery Higher HCC coding for Healthcare

  • Medical Health Record
  • Artificial Intelligence
  • Healthcare

Health Insurance companies still utilize manual coders to keep track of up to 1,00,000 ICD codes with slight exceptions and extract insights from complex medical documents. With that came the requirement of eradicating the manual medical coding error rate that normally has been recorded as 33%

The process involves multiple chart reviews per patient and hybrid measurements require the review of medical records, thus increases the review time per patient. This seemed like an impossible challenge.

47Billion acted beyond a technology vendor for the client and deployed a HEDIS Audit management ICD Engine.

The platform was helpful for the health insurance companies and ultimately generated ROI for the client –

  • Up to 150% Increase in the number of HCCs matched as compared to the manual process
  • US$ 3000 compensation to an insurance company for every patient found with HCC
  • Increased coding speed and improved overall coding accuracy by up to 98.2%
  • Filters a higher percentage of false positives
  • Reduced coding time to 20%

The use case explains how the platform helped in revolutionizing the health insurance company processes. 

Download a copy of the case study to learn how they achieved the claims processing success.

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