Audit-ready. Extrapolation-resilient. Revenue-protected.
Built for the new RADV era
Strengthen your Medicare Advantage compliance and secure your bottom line, even in the face of annual RADV audits and new extrapolation methods. Reveleer’s next-generation RADV Audit Solution combines AI-powered retrieval, intelligent coding validation, and rapid submissions for confident audit response and financial resilience.
Defensible audit response
Full workflow traceability across multiple lines of business ensures you can defend every code and every chart.
Comprehensive retrieval
Retrieve up to 96,000+ pages of structured and unstructured data per hour from disparate sources for real-time audit insight.
Proven results
Our clients report up to 65% acceleration in audit readiness, 40% operational cost savings, and audit acceptance rates over 98%.
///AI meets risk adjustment for superior results
Reveleer’s Risk Adjustment software enhances health plan efficiency while improving HCC capture and RAF accuracy. By integrating AI into clinical workflows and delivering fast and precise insights, customers see a 3X return on investment within a year.
////How AI-powered risk adjustment tripled coding speed
A large regional health plan needed to scale its risk adjustment programming as its Medicare Advantage business grew. It used Reveleer’s Risk Adjustment suite to help code 1.2 million charts in 4 months, tripling its coding speed.
1.2 million charts
To quickly analyze a high volume of charts, the health plan leveraged Reveleer’s Evidence Validation Engine (EVE™) to pinpoint the most relevant evidence for each case.
40% increase in value per chart
EVE™ assisted the plan’s coders by validating existing diagnoses and uncovering potential missed conditions, significantly increasing the value of each chart.
30% more efficient workflows
Reveleer’s Risk Adjustment suite facilitated collaboration among the plan’s coding teams and saved countless hours of time previously spent manually reviewing each chart.
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Key benefits of Reveleer's RADV Audit Solution
Accelerated medical record retrieval
Leverage advanced automation to locate, request, and retrieve high volumes of records up to 80% faster than manual workflows. Reveleer's record retrieval matches every document across current and legacy systems, multiple years, and different provider networks to the correct audited enrollee, so no chart is left behind.
AI-driven diagnostic validation
Reveleer's proprietary Evidence Validation Engine (EVE™) to surface, validate, and map diagnoses to the correct HCCs with up to 99% accuracy. EVE instantly reviews medical documentation, catching unsupported or missing conditions before CMS does and minimizing your extrapolated repayment risk.
Streamlined provider attestations and submission
From automated outreach and tracking of provider attestations to creating CMS-ready submission packages, Reveleer takes the complexity out of audit season. Track documentation and audit readiness for every contract, with on-platform project visibility and reporting.
Quality assurance, from sample to submission
Mitigate financial exposure with multi-level QA, coding overreads, and audit logs, ensuring defensible, compliant submissions. Built-in validation alerts coders to potential issues so that errors are corrected before submission, not after an audit.
Scalable, configurable engagement
Whether you need full-service support, software-only, or a hybrid model, Reveleer adapts to your operation. Engage expert consulting, mock audits, and compliance guidance on your terms—with flexible tiers and transparent pricing.
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HCC optimization made smarter with AI-powered retrospective risk adjustment
For health plans and providers, effective retrospective risk adjustment is key to success in value-based care. Accurate, efficient programs support fair reimbursement, high-quality care, and financial sustainability. With AI, organizations can drive targeted HCC optimization and improve financial, clinical, and compliance outcomes.
One platform for value-based care
Intelligent data acquisition, at scale
The Reveleer platform extracts more than 96K pages of structured and unstructured clinical data, consolidated from several disparate clinical systems to deliver insights in real time across value-based care programs.
EVE™, Evidence Validation Engine
EVE guides abstractors to member insights linked seamlessly to clinical source documentation to optimize the clinical review process.
Patient Index, a holistic view of care
Patient Index is a consolidated collection of linked patient data mined from multiple sources and systems for a unified view of patient care across member management, risk adjustment and quality improvement.
More information on RADV audits
What is a RADV audit?
A RADV audit is an annual process mandated by CMS for all Medicare Advantage plans. It requires plans to validate the accuracy of diagnosis codes submitted for risk adjustment payments. RADV audits exist to ensure compliance and data integrity, and there are significant financial risks if errors are found and extrapolated across contracts.
What are the recent changes in RADV audit requirements?
In May, CMS introduced changes to the RADV program that require expanded audits with larger sample sizes (up to 200 members per contract) and look-back periods covering multiple years (records dating back to 2018). Read more about the recent RADV updates on our blog.
How does automation help in the RADV audit process?
Automated RADV audit solutions streamline workflows through project data ingestion, multi-channel medical record retrieval, AI-powered coding and QA, and provider attestation management. The result is faster processing, cost savings, and higher submission accuracy so that health plans can gain peace of mind when it comes to risk adjustment compliance.
What happens if a health plan fails a RADV audit?
Plans may face significant financial recoupments if error rates identified in the audited sample are extrapolated across the entire contract. Early preparation is critical to reducing operational disruption and minimizing financial risks.
Are Reveleer’s technology solutions CMS and HIPAA-compliant?
Yes, the entire Reveleer platform is compliant with CMS, HIPAA, and other regulatory bodies. We designed our platform workflows to align with CMS requirements, and our team keeps a close eye on the ever-evolving regulatory landscape to ensure processes from data acquisition to CMS submissions meet the highest regulatory standards.
What other solutions does Reveleer provide to support success in value-based care?
In addition to our powerful Risk Adjustment suite, Reveleer offers a single platform for value-based care that incorporates Quality Improvement, Clinical Intelligence, and health plan Member Management technology suites.
Related Resources
Learn how AI-powered risk adjustment technology can make all the difference in increasing speed and accuracy.
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