A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't ...

Proprietary Confidence Score and agentic tools improve performance and value for risk-bearing payers HERNDON, Va.--(BUSINESS WIRE)--ECLAT Health Solutions, a leading risk adjustment and coding ...

RAAPID's AI-powered risk adjustment solution received an A+ would-buy-again grade (Emerging Data, n=5) from interviewed ...

Artificial intelligence (AI)-enabled tools such as natural language processing (NLP) have been integrated into a wide range of applications, including risk adjustment coding tools, for greater ...

Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General ...

CMS and policy makers could pursue simple, incremental reforms to reduce overpayment in Medicare Advantage while also paving the way for longer-term solutions to reduce incentives to upcode. To ...

Change Healthcare has announced it is collaborating with Health Fidelity on a risk adjustment solution to provider greater accuracy for better compliance and more precise reimbursement. Health ...

NEW YORK, February 04, 2026--(BUSINESS WIRE)--Datavant, the data collaboration platform trusted for healthcare, today announced that it has been named the #1 Ranked 2026 Best in KLAS Award winner in ...

The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries’ baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if ...

A federal lawsuit has focused attention on how the industry uses medical codes for risk adjustment. While the lawsuit doesn’t involve physician practices, it’s a heads-up for them to pay attention to ...

More Medicare Advantage plans got star ratings of four or more for 2022 as some experts renew criticism of risk adjustment practices that can lead to greater quality performance.

Healthcare risk management solutions company Talix has launched Coding InSight for Payers. Coding InSight for Payers is designed to help health plans automate and streamline risk adjustment processes ...