Change Healthcare, Health Fidelity partner on AI solution for risk adjustment coding

Change Healthcare and Health Fidelity are partnering to offer a risk adjustment coding solution that uses natural language processing (NLP) and machine learning to increase claim accuracy and address compliance issues, the companies announced Monday, Jan. 14.

The companies hope their partnership will help provide greater accuracy, better compliance and more precise reimbursement for payers. Change Healthcare is a revenue and payment cycle management and clinical information exchange solutions company. Health Fidelity is a healthcare technology startup. 

“With their scale, established payer relationships, and years of coding experience, Change Healthcare is the ideal partner to extend the reach of our natural language processing within risk-adjustment coding,” Steve Whitehurst, Health Fidelity chief executive officer, said in a prepared statement. “The resulting combination of analytics, artificial intelligence, and services allows us to customize our solutions to meet customer goals and improve overall performance and outcomes.”

The risk adjustment solution is designed to help Medicare Advantage, ACA commercial and Medicaid payers, according to a press release. Through the partnership, the companies said the solution will use analytics, chart retrieval, coding and submission with NLP and AI technology during the coding phase of risk adjustment. 

“Risk adjustment requires a high level of clinical data acquisition and careful analysis of millions of medical records to assign the proper diagnosis code to claims,” Doug Duskin, senior vice president and general manager of clinical review at Change Healthcare, said in a statement. “Health Fidelity’s NLP engine has demonstrated very high sensitivity in identifying ICD and HCC codes, enabling their clients to realize a 20 [percent] to 30 percent increase in risk capture. This added capability is exciting as we expect it will lead to better gap closure and improved quality of care and outcomes for members.”