Health Data Max is transforming the future of risk adjustment through AI-enabled, end-to-end automation for Medicare Advantage payers, ACOs, and risk-bearing providers.

Our Risk Adjustment SaaS Platform unifies the entire lifecycle — from prospective suspecting and retrospective chart review to encounter validation, submission tracking, and RADV audit readiness — powered by Agentic AI and healthcare-trained large language models (LLMs).

We help organizations move beyond manual workflows and fragmented systems by providing real-time visibility into every encounter and submission. Our platform analyzes historical claims, lab, and pharmacy data to identify missed or under-documented HCCs, automates chart review using NLP copilots, and validates documentation against CMS submission logic — ensuring compliance, accuracy, and complete revenue capture.

Key Capabilities:

Prospective Suspecting: Predict and prioritize under-coded members using historical and predictive data.

Retrospective Review: AI copilots extract diagnoses, evidence, and coding gaps from unstructured medical charts.

Agentic AI Validation: Automate claim-to-chart verification and detect missing, unsupported, or duplicate submissions.

RADV-Focused LLM Models: Purpose-built models simulate CMS audit logic to flag risk exposure and suggest corrective actions.

Lifecycle Tracking: From patient visit to CMS submission and audit resolution — full traceability in one secure platform.

With Health Data Max, organizations can proactively identify risk, ensure data integrity, and recover missed revenue — all while maintaining compliance and audit readiness.

Revolutionizing Risk Adjustment — from Prediction to Proof.
🌐 www.healthdatamax.com

Health Data Max LLC

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