Amidst intensifying RADV audits and shifting CMS policy, single-chart risk adjustment and HEDIS review streamlines payer workflows and improves returns

HERNDON, Va.: #ACA--ECLAT Health Solutions, a leading risk adjustment, coding and quality technology partner for Medicare Advantage, Medicaid and ACA plans, will showcase unified risk and quality review functionality within its evaire platform at RISE West in San Diego, September 2-4. The new functionality uses agentic AI to review risk adjustment and quality (HEDIS and Stars) in a single coordinated pass, rather than through separate, siloed reviews, saving health plans unnecessary steps and reducing duplicative reports.

“Health plans have spent years running risk and quality as separate reviews, sometimes creating inconsistent findings that are tricky to align and difficult to defend. It’s an antiquated process that slows workflows and complicates reporting,” said Gabe Stein, CEO, ECLAT Health Solutions. “With purpose-built AI, evaire eliminates the need for two separate processes, simultaneously creating a clean, defensible record of both risk adjustment and quality measures within just one pass.”

evaire’s purpose-built agentic AI reads a member’s chart once, abstracting risk adjusted ICDs and quality measure evidence in parallel while the member, chart ID and medical record remain constant throughout the review. The unified process reduces duplicate efforts, giving risk and quality teams a single, shared source of truth at faster speed and stronger accuracy compared to manual review processes.

Alongside single risk and quality reviews, the end-to-end evaire platform uses AI to power chart retrieval, coding and analysis tools to improve risk adjustment and quality initiatives. By consolidating and automating multiple steps in the review, retrieval and submission process, evaire accelerates both efficiency and accuracy, flagging records with changes, adds or deletes. Payers using evaire estimate they will significantly reduce the volume of charts requiring manual review, saving time and resources while maintaining or increasing coding accuracy.

Meet with ECLAT at RISE West in booth #307/309 to learn about unified risk and quality review, and understand how evaire supports RADV readiness, coding accuracy and quality gap closure amid intensifying regulatory pressure.

About ECLAT Health Solutions

ECLAT Health Solutions is a leading revenue cycle, risk adjustment and healthcare technology partner. Fueled by its agentic AI platform, evaire, and highly qualified professionals, ECLAT helps hospitals, health systems and providers strengthen medical coding, AR and other revenue cycle operations, while payers rely on evaire to advance risk adjustment and quality programs with greater accuracy and efficiency. By pairing expertise and automation across the healthcare continuum, ECLAT drives measurable outcomes and delivers transparent, defensible results that healthcare organizations can trust. Learn more at ECLAThealth.com.

Fonte: Business Wire