Innovative service applies AI-powered NLP to uncover adds, deletes & corrections

September 10, 2020 – Alpharetta, GA – Ciox Health™, a leading health technology company, has expanded its risk adjustment coding services with Cross Check – a service for advancing coding accuracy, automating second-level reviews and delivering improved results. The innovative solution is powered by the latest natural language processing (NLP) and machine learning, and a proprietary rules-based coding engine backed by a team of certified Ciox coders.

Payers rely on member-chart code reviews to accurately reflect a plan’s population risk and establish reimbursement. First pass manual reviews are costly, requiring skilled professionals to search hundreds or thousands of pages daily for qualifying codes. To ensure codes are not missed, or included inadvertently, most health plans count on a second level review to increase accuracy and remain compliant.  First, second, and often even third level reviews done manually increase accuracy but at compounding costs, eventually leading to diminishing returns.

Ciox Cross Check automates code reviews, relieving much of a health plan’s burden while reducing costs significantly and improving accuracy. Additionally, a team of certified coders validates the automated results to confirm recommended adds, deletes and corrections. The service is designed to support varying coding initiatives, including second-level coding review and reconciliation versus prior claims submissions.

Applicable to any health plan’s retrieved charts, Ciox Cross Check runs as a service, requiring no software set-up and minimal training. Coding teams are presented with user-friendly dashboards identifying charts with missed opportunities, adds or deletes, allowing them to focus on significantly fewer overall charts before submitting. As a result, health plans can expect greater accuracy, speed, efficiency, and compliance – all while allowing each to code within varying degrees of risk tolerance.

“Ciox significantly improved accuracy of pre-existing NLP technology for the Cross Check solution by incorporating AI coupled with machine learning and a dynamic rules engine built from proprietary style sheets within, plus backed it up with a team of certified coders to add an extra degree of confidence,” said Andy Kumar, VP of Product for Ciox Health. “With continual experiential learning feeding into its engine, Cross Check is always improving and aligned to the needs of risk adjustment.”

“Demand for high quality outcomes at speed through easy-to-use, cost-effective technology continues to grow in healthcare, especially within the Medicare Advantage and ACA markets,” said Ciox Chief Product Officer, Nick Giannasi. “The combination of relevant and diverse data, human domain expertise and advances in NLP technology enables us to achieve these goals for coding. Ciox Cross Check is a service powered by Human and Artificial Intelligence to rapidly deliver impactful results and value to end users.”

Ciox is hosting a roundtable featuring Cross Check on September 10th from 1pm-2pm EDT during the RISE West virtual conference. The session, “Enhanced HCC Coding and Second Level Reviews using NLP with Artificial Intelligence,” is a two-part discussion on the technology behind AI-powered Natural Language Processing and the impact on HCC Coding and Second Level Review. The roundtable is available to all RISE West attendees; register at www.risewestsummit.com.

To learn more, request a demo or get started with Ciox Cross Check, visit https://www.cioxhealth.com/solutions/second-level-review-coding

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