HCC Validator — Built for Compliance & RADV Readiness

Validate HCCs in real time to ensure every diagnosis
meets MEAT criteria and stands up to audits.

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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.

Why It Matters

In value-based care, unsupported diagnoses create real risk—for both revenue and compliance.

Financial risk: Unsupported HCCs can lead to RADV recoupments 
Compliance risk: Non-MEAT diagnoses increase audit exposure 
Operational risk: Poor documentation impacts RAF accuracy, STAR ratings, and trust

Our Solution: The Inferscience HCC Validator

Dual Approach: Concurrent + Retrospective HCC Coding Validation

Concurrent Validation

Real-time MEAT compliance check during provider documentation
Instant provider feedback to correct or add supporting documentation
Prevents inaccurate or unsupported codes from entering the claim stream
Improves first-pass coding accuracy and RAF integrity

Retrospective Validation

Post-encounter review of submitted diagnosis codes
Identifies MEAT deficiencies and coding errors
Identifies OIG high target codes and potential audit risk
Flags documentation gaps for provider education
Creates defensible audit trail for RADV preparedness

RADV Audit Defense Built In

Maintain a compliance-ready coding library
Automated audit packages with source documentation linking
Identify high-risk codes before they trigger CMS recoupment
Demonstrate proactive oversight to regulators and partners

Key Benefits to Providers & Health Plans

Reduce RADV recoupment risk:
Save millions in potential paybacks

Increase coding accuracy:
Higher RAF scores & risk revenue

Improve provider performance:
Ongoing documentation education

What Our Clients Say

“In 8 months, our organization has presented more than 269K HCC codes to Providers and Advance Providers. Our coders and 300+ primary care providers find it to be very straightforward and user friendly.”

athenaOne User
Billing Staff, Multispecialty

“Inferscience really speeds up the HCC process. It’s a great tool for providers as well as coding personnel in catching opportunities throughout the entire chart.”

athenaOne User
Administrative Staff, Multispecialty

“It has been a great opportunity to work with the Inferscience program, it is very user friendly. It enhances our accuracy and consistency with the HCC coding and allows us to produce quality service for our providers.”

athenaOne User
Administrative/Clerical Staff, Multispecialty

AI Solution for Healthcare Payers

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.

Integrate with Ease

Payers or third-party vendors connect the API to their existing system.

Upload Data

Claims files are uploaded (PDF or CCDA documents), after which the data is extracted and analyzed using intelligent rules.

Retrieve Analysis

The API delivers analysis in JSON format that can be retrieved in seconds.

Let’s talk about how our HCC Validation Platform can safeguard your plan.