NLP RISK ADJUSTMENT SOLUTION

Improve accuracy and optimize risk adjustment coding

Organizations are challenged with accurately identifying and documenting risk-adjusted conditions. Manual chart review is time consuming and has limited scalability.

The IQVIA Natural Language Processing (NLP) Risk Adjustment Solution supports payer and provider organizations across the healthcare industry with an accurate, efficient and comprehensive solution to accelerate risk adjustment coding.

IQVIA NLP Risk Adjustment Solution

Our NLP Risk Adjustment Solution combines award-winning healthcare NLP with exceptional domain expertise to transform unstructured medical records into highly accurate coded data to:

  • Accelerate your risk adjustment process: empower coding teams to automate and prioritize workflow queues to eliminate backlogs and optimize performance.
  • Accurately code unstructured text:  Support your clinical teams with unparalleled healthcare NLP to enable coders to review and validate medical records with minimal effort and expense, speeding up the decision-making process.
  • Automatically track activity: produce a comprehensive audit trail to ensure all clinical codes and reviewer actions can be easily distributed to reduce the chance of compliance risk.

AI with Clinical Intelligence

The NLP risk adjustment solution uses clinically intelligent healthcare NLP to find clinical conditions within medical records in their correct clinical context.

Identify HCC and ICD10-CM

Advanced AI powered chart extraction drives accurate and actionable diagnoses from unstructured data to reduce the risk of errors.

Our intuitive interactive interface displays extracted diagnoses and codes for the coder to validate.

NLP also supports broader population health and risk stratification initiatives with publication grade accuracy.

Our NLP Platform has been proven to uncover 55% more diagnoses than ICD10-CM codes alone.

Track progress and productivity

Our NLP Risk Adjustment Solution has built-in dashboarding tools for timely, reliable intelligence to enrich your coding team’s analysis and track progress and productivity.

The integrated NLP workflow enables an automatic assignment of new patient encounter data to increase efficiency and frees you up to focus time and resources on high-value activities.

Repeatable, Reproducible, Robust

By harnessing the power of our core NLP expertise and technology and the NLP Data Factory, 8 million records can be processed an hour.

Accurately surface and normalize features such as HCC and ICD10-CM codes in a repeatable, reproducible and robust pipeline.

Tailored Solution

Healthcare data is often complex and messy. IQVIA offers a suite a of pre-processors to deal with different sources and formats: Including Optical Character Recognition (OCR) correction for scanned PDFs, regions detection for Consolidated Clinical Document Architecture (CCDAs) or Health Level Seven (HL7).

A variety of deployment models are available, including on premise, private cloud or OnDemand.

Industry Experts

Our dedicated industry experts will take you through every step of the way from deployment to training.

Our team will shape and optimize delivery fit to your needs to ensure that all implementation aspects are satisfied.

Reduce compliance risk

Our solution provides a comprehensive audit trail of accepted ICD10-CM codes to support claims submitted to CMS.

The automatic and managed audit trail assists you and your organization in understanding both the present and past states of coding validation.

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