HCC Validator checks every diagnosis against MEAT criteria in real time — before it’s submitted — so unsupported HCCs never reach the claim and your documentation is audit-ready by default.
As CMS audit scrutiny increases, accurate documentation matters more than ever. HCC Validator helps payers and providers confirm that HCCs are properly supported—before submission —reducing audit risk and strengthening compliance.
HCC Validator removes the three biggest sources of risk-adjustment exposure before they cost you:
HCC Validator validates codes at two points — during documentation (concurrent) and after submission (retrospective) — so errors are caught before they enter the claim stream and again before they reach an auditor.
As CMS phases out unlinked chart review as a submission path, every HCC must trace to a documented, MEAT-supported encounter. HCC Validator enforces that link at the point of care and flags any diagnosis that can’t stand on its own — so your risk adjustment stays defensible under CMS-HCC V28 (100% for payment year 2026).
Reduce RADV recoupment risk:
Save millions in potential paybacks
Increase coding accuracy:
Higher RAF scores & risk revenue
Improve provider performance:
Ongoing documentation education
Our healthcare API empowers payers and third-party vendors to harness advanced HCC coding analysis, facilitating healthcare interoperability and delivering deeper insights to address the evolving needs of patients, providers, and payers.
Payers or third-party vendors connect the API to their existing system.
Claims files are uploaded (PDF or CCDA documents), after which the data is extracted and analyzed using intelligent rules.
The API delivers analysis in JSON format that can be retrieved in seconds.
HCC validation software checks that each coded diagnosis is properly supported before it’s submitted for risk adjustment. HCC Validator does this in real time, confirming every HCC meets MEAT criteria and flagging any that don’t — so unsupported codes are corrected before they create audit or recoupment risk.
A RADV (Risk Adjustment Data Validation) audit is CMS’s review of whether the diagnoses a plan submitted are supported in the medical record. The best preparation is to validate HCCs before submission: HCC Validator maintains a compliance-ready coding library, links every code to its source documentation, and generates audit packages, so you can demonstrate support on demand rather than scrambling after an audit notice.
MEAT stands for Monitor, Evaluate, Assess, and Treat — the documentation standard that shows a diagnosis was actively addressed during an encounter. HCC Validator checks each HCC against MEAT criteria automatically and prompts for the supporting detail when it’s missing.
Concurrent validation happens during documentation, giving providers real-time feedback to fix or add support before a code is submitted; retrospective validation reviews already-submitted codes to catch MEAT deficiencies and flag audit risk. HCC Validator does both, so errors are caught before they enter the claim stream and again before they reach an auditor.
By confirming every HCC is MEAT-supported before submission and flagging OIG high-target and high-risk codes, HCC Validator keeps unsupported diagnoses out of the claim stream — the diagnoses that trigger recoupment. It also builds a defensible, source-linked audit trail so supported codes hold up under review.
Yes. HCC Validator is maintained against the current CMS-HCC V28 model, which reached 100% implementation for payment year 2026, and validates documentation against V28’s tightened support requirements.
HCC Validator is built for health plans, provider organizations, and ACOs in Medicare Advantage and value-based arrangements that need to reduce audit exposure and protect risk-adjusted revenue. It works alongside HCC Assistant, which handles real-time coding at the point of care.
