From RADV audit defense to prospective HCC coding, RADVantage.io delivers hands-on services that protect revenue, improve documentation accuracy, and build organizational capability at every level.
We work where the complexity actually lives — inside health plan audit cycles, provider encounter data, and the documentation workflows that determine whether your risk scores hold up.
Pre-audit preparation, medical record retrieval support, HCC validation, discrepancy analysis, and response strategy for CMS Risk Adjustment Data Validation audits.
Health PlansChart review and outreach support ahead of each plan year to ensure chronic conditions are documented, addressed, and coded accurately before encounter submission.
Health PlansPost-encounter chart audits that identify missed HCCs, unsupported diagnoses, and documentation gaps before they become audit liabilities.
Health PlansEmbedded or remote HCC coding specialists supporting your clinical team with real-time diagnosis capture, CDI querying, and coder education.
Provider GroupsBuild or strengthen your clinical documentation improvement program with workflow design, provider education, query templates, and ongoing performance tracking.
Provider GroupsCustom HCC curriculum for coders, CDI specialists, and providers delivered through RADVantage.io's learning platform or live instructor-led sessions.
BothCMS Risk Adjustment Data Validation audits have grown in scope and consequence. A single unsupported HCC across your sample can trigger extrapolated repayments across your entire membership. RADVantage.io brings specialized audit defense that starts before CMS ever contacts you.
We analyze your encounter data and HCC submissions to identify the diagnoses most likely to draw scrutiny — before your sample is selected.
Systematic outreach to provider offices, organization of records per CMS specifications, and documentation gap analysis prior to submission.
Line-by-line clinical review of each submitted HCC against supporting documentation. We confirm what holds, flag what doesn't, and build the corrective record.
We draft the technical and clinical response to CMS findings, support the appeals process, and advise on corrective action plans to prevent recurrence.
Full-cycle RADV defense engagement
Pre-sample risk scoring across your full beneficiary population to surface HCC vulnerability before CMS selection.
Structured record request workflows with tracking, escalation, and deadline management built in.
CRC-certified coders conduct chart-level review against ICD-10 and HHS/CMS coding guidelines for each submitted condition.
Actionable summary of risk exposure with prioritized remediation steps mapped to your specific audit sample.
Drafting of technical rebuttals, supporting evidence compilation, and representation strategy through the full appeals lifecycle.
Structural improvements to documentation workflows, provider education, and data submission protocols to reduce future audit exposure.
For MA plans, ACA plans, and Medicaid managed care organizations, risk adjustment accuracy isn't optional — it's the foundation of financial sustainability. Our coders work your data, your providers, and your timelines.
Prospective review happens before the encounter — we analyze historical claims, identify members with suspected chronic conditions, and support provider outreach so every visit results in complete, accurate documentation. This is the highest-ROI intervention in risk adjustment.
Retrospective review closes the gap between what happened clinically and what was submitted to CMS. Our coders review closed encounters to find both missed HCCs that can be added and unsupported diagnoses that represent audit risk — giving you a full picture before submission deadlines.
Coding operations without measurement are flying blind. We deliver regular reporting on RAF score trends, HCC capture rates by provider and market, sweep completion progress, and risk-adjusted revenue projections — giving your leadership the data to make confident operational decisions.
Risk adjustment is one of the largest revenue drivers for MA plans — and one of the most exposed.
We maintain real-time expertise in both the CMS-HCC V24 and V28 models, including the blended transition years. Our coders are trained on the diagnosis mapping changes, category consolidations, and new condition inclusions that affect your RAF scores right now.
Talk to a Coding SpecialistDocumentation deficiencies at the provider level cascade into plan-level risk — and audit liability.
Provider groups participating in value-based contracts, ACOs, or MA networks carry real risk when chronic conditions go undocumented. We partner directly with your clinical teams to build documentation discipline that holds up under audit — and captures the revenue your patients' care actually justifies.
Embedded or remote coders available for real-time diagnosis capture during or immediately after clinical encounters — so nothing is left to memory at month-end.
We build clinically appropriate query templates and train your CDI team to engage providers effectively — improving response rates and documentation specificity without compromising clinical integrity.
AWVs are the single best opportunity to assess and document all active chronic conditions. We help your practices maximize AWV completion rates and ensure each visit drives complete HCC capture.
HCC capture rate scorecards by provider, specialty, and location — giving your medical director the visibility to target education where it will move the needle most.
Targeted provider and coder education on condition-specific ICD-10 coding, HCC hierarchies, and the documentation language CMS requires to support each code.
We built RADVantage.io because the existing options were either too generalist, too transactional, or too removed from the clinical realities of risk adjustment work.
We don't do general medical billing, general coding, or EHR implementation. Risk adjustment is all we do — which means our depth in HCC models, RADV rules, and documentation standards is unmatched.
Every coder on our services team holds CRC certification. We don't subcontract to general coding pools — each engagement is staffed with specialists who have worked MA, Medicaid managed care, and ACA risk adjustment programs.
Most services firms hand off a report and walk away. We connect every engagement to our learning platform — so the education that prevents the next gap is built into the workflow, not bolted on after the fact.
V28 is not optional. We maintain real-time training on every CMS model update, transition year mapping, and HHS-HCC rule change — so your team is never operating on last year's standards.
Every record we review, every HCC we flag, every discrepancy we document is traceable. We provide complete audit-ready work product — not summary reports that leave you unable to defend the methodology.
You'll have a named engagement lead, not a ticket queue. We operate on your timelines, communicate proactively, and treat your audit exposure with the urgency it deserves.
Every client relationship starts with understanding your data, your contracts, and your current gaps — before we recommend anything.
We review your encounter data, current HCC submission history, and any existing audit findings to establish a clear baseline — where you are, where the gaps are, and what the exposure looks like.
We scope the work to your specific need — not a pre-packaged service bundle. Whether that's a targeted RADV prep sprint, an ongoing prospective program, or a full CDI buildout, the engagement is structured around your calendar and capacity.
Your dedicated engagement lead oversees delivery, maintains communication cadence, and ensures that every work product meets the documentation standard required for clinical and regulatory scrutiny.
We close every engagement with actionable findings, performance metrics, and — where relevant — the training content and workflow tools your team needs to sustain the improvement without ongoing dependence on outside support.
We work across all three risk adjustment program types — CMS-HCC, HHS-HCC, and CDPS/RxHCC models.
Project-based, retainer, or embedded — we structure around what your team actually needs.
BAA-ready, compliant data handling, and secure record transmission protocols for every engagement.
Every engagement includes defined KPIs — HCC capture rate, RAF delta, audit finding rate — tracked and reported throughout.