Risk Adjustment
NLP Suspecting

Reviewing patient chart data to identify potential missed conditions takes a lot of time—and clinical staff and providers are simply too busy to comb through all that data manually. Natural language processing (NLP)-derived suggestions can alleviate this burden by combing through historical clinical documentation to deliver a list of potential missed conditions for providers to evaluate.

Edifecs NLP Suspecting applies NLP, machine learning, and highly evolved clinical engines to highlight risk-adjustable conditions that are currently unconfirmed but are likely to exist based on advanced predictive modeling. These suspected conditions are presented for clinical review and validation, enabling clinicians to intervene early and address these conditions in the next visit or with proactive patient outreach. By providing a comprehensive picture of patient health status, Edifecs NLP Suspecting helps providers deliver better care outcomes, improve coding and documentation accuracy, and ensure complete and compliant risk capture.


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intervene

  • Incorporate suspected conditions into pre-visit planning workflows
  • Help providers ask the right questions and support better care outcomes
  • Support retro review workflows with targeted chase lists for record retrieval

Get involved earlier

Take a more proactive approach to patient care

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uncover

  • Capture up to 30% more conditions than claims-based suspecting
  • Incorporate more than 90% of all available patient data into risk adjustment systems
  • Surface suspects for coder review ahead of patient visits

Spot the opportunities

NLP Suspecting has a 95% accuracy rate for risk category capture

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extract

  • Increase RAF value by up to 10% with NLP-derived suspects
  • Synchronize industry best practices, CMS policies, and customizable business rules
  • Accommodate FHIR standards or flat files with flexible data integration capabilities

Apply your information

Easily ingest clinical and claims data for faster review by clinical teams


Find out how we can support your health plan's performance.