Medicare Advantage | CMS-HCC | Risk Adjustment
Alpine Pro Health delivers certified, AI-assisted Hierarchical Condition Category (HCC) coding that captures every chronic condition, improves reimbursement accuracy, and keeps your Medicare Advantage plans fully CMS-compliant.
Accuracy
Accuracy
Accuracy
Alpine Pro Health is a trusted partner in delivering accurate, compliant, and denial-free risk Adjustment solutions for healthcare organizations, including services such as:
● Ensures accurate and complete documentation of patient conditions
● Utilizes expert coding to reduce errors and minimize claim denials
● Maintains full compliance with CMS and payer-specific guidelines
● Captures all risk-relevant conditions to optimize revenue
● Provides end-to-end support for RADV audits
Patient Encounter
ICD-10 Code Assignment
HCC Category Mapping
RAF Score Calculation
CMS Payment Adjustment
Pre-visit chart reviews that identify care gaps, flag unaddressed chronic conditions, and prepare physicians to document all HCC-relevant diagnoses before the patient encounter — maximizing capture rates from the first touchpoint.
Post-encounter medical record review to capture missed or under-coded diagnoses. Our certified coders identify clinically-supported conditions that were not properly coded, correcting and supplementing risk scores to recover lost reimbursement.
Our LLM-powered platform analyzes clinical notes, lab results, and problem lists to surface HCC-relevant conditions for coder review — boosting productivity 3x while maintaining 98%+ accuracy. The same GenAI technology powering our inpatient and risk adjustment products.
Independent audits of coded encounters to validate accuracy, identify systematic errors, and ensure RADV audit readiness. Every coded encounter includes full documentation linkage and coding rationale — protecting your organization from CMS payment claw-backs.
Comprehensive analysis of your current RAF scores against patient clinical profiles to identify documentation gaps, recapture opportunities, and potential risk score uplift across your entire member population — turning data into reimbursement.
Our GenAI-powered HCC coding platform combines clinical intelligence, certified coders, and automation to achieve outcomes no manual process can match.
Utilizes NLP and machine learning to extract and assign accurate HCC codes directly from unstructured clinical notes, problem lists, and discharge summaries — identifying conditions often missed in manual review.
Automatically updates RAF scores as diagnoses are coded, providing real-time visibility into patient risk and reimbursement impact across your entire Medicare Advantage membership.
Identifies missed or unsupported diagnoses and flags documentation gaps before submission — preventing revenue leakage and reducing the risk of CMS payment adjustments.
Verifies that each HCC is fully supported by clinical evidence, ensuring readiness for RADV and payer audits. Every code includes a documentation trail that withstands CMS scrutiny.
Enables real-time and forward-looking reviews to ensure timely and accurate risk adjustment before, during, and after patient encounters — closing gaps across all review types.
Integrates with 200+ EHR platforms including Epic, Cerner, Athena, and eClinicalWorks. Supports RAPS/EDPS submission formats and health plan data warehouse compatibility.
We combine CRC-certified coding expertise with AI automation to deliver accuracy, speed, and compliance — so you never leave reimbursement on the table.
Our team holds CRC (Certified Risk Adjustment Coder), CPC, and CCS credentials with an average of 8+ years in HCC and risk adjustment coding across Medicare Advantage plans.
Rigorous multi-level QA, dual-coder review for complex cases, and AI-driven validation ensure accuracy rates that consistently exceed CMS and RADV benchmark thresholds.
Our NLP engine reads unstructured clinical notes to surface HCC-relevant diagnoses — identifying chronic conditions often missed in routine coding, improving capture rates by up to 40%.
Every coded encounter includes full documentation linkage, supporting evidence citations, and coding rationale notes — ensuring you pass CMS RADV audits without payment claw-backs.
Standard 24–48 hr TAT for prospective coding and 72 hrs for retrospective reviews, with dedicated project managers ensuring on-time delivery for high-volume engagements.
SOC 2-aligned infrastructure, end-to-end encryption, signed BAAs, and strict access controls protect your PHI at every step of the HCC coding workflow.
LLM-driven condition identification with coder validation
Full documentation trail for every coded HCC
48-hour TAT with up to 40% RAF score improvement
A streamlined, AI-assisted workflow that ensures every chart is coded accurately, every condition is captured, and every submission is audit-ready.
Secure receipt via EMR integration or encrypted file transfer
LLM scans notes and generates HCC-relevant condition summary
CRC-certified coders validate and assign ICD-10 / HCC codes
Multi-level quality review, error correction, documentation check
RAF reports, gap dashboards, and RAPS/EDPS-ready data files
Our coders are trained across all 86+ CMS-HCC categories with deep expertise in the highest-weight chronic conditions that drive the most significant RAF score and reimbursement impact.
Partner with Alpine Pro Health's certified IP-DRG coders and start capturing every dollar your facility has earned — compliantly and accurately.
Established in 2022, Alpine Pro Health. delivers accurate, compliant, and efficient medical coding and RCM solutions. Trusted by U.S. healthcare providers for expert-driven, end-to-end services.
131 Continental Dr, Suite 305, City of Newark, County of New Castle, Delaware 19713.
97, 98, Level 1, Magna Square, Jawaharlal Nehru Rd, Ashok Nagar, Chennai, Tamil Nadu, 600083, India
All Rights Reserved © 2025 Alpine Pro Health