AI to Accelerate Clinical Coding

Solution:
AI-Powered Coding with Reveleer's Evidence Validation Engine

To manage the massive volume of more than 1 million charts within strict retrospective risk adjustment timelines, the BCBS Plan turned to Reveleer’s clinical coding solution, powered by our proprietary Evidence Validation Engine (EVE).

EVE analyzed clinical data received from providers and pinpointed the most relevant evidence for each case. EVE then presented this evidence to human coders for efficient review and validation, assigning coders in validating existing diagnoses and uncovering potential missed conditions supported by sufficient evidence. This ensured capture of all relevant HCCs, leading to more accurate RAF scores.

The health plan identified the value of Reveleer's platform beyond coding productivity. The SaaS platform empowered teams to collaborate seamlessly, leveraging built-in analytics for deeper visibility into key performance metrics. This included tracking productivity, monitoring work completion rates, and gaining insights into individual chase-level tasks. This comprehensive view facilitated data-driven decision making for future risk adjustment cycles.