Case Study: Capital BlueCross Improves Risk Adjustment Accuracy and Efficiency with Apixio HCC Identifier

Improving Risk Adjustment Accuracy & Efficiency with HCC Identifier

Capital BlueCross, a Pennsylvania-based health plan serving Medicare Advantage and ACA members, needed a more efficient and accurate way to manage risk adjustment. After first-pass chart reviews were completed by an external coding vendor, its small internal team faced a time-intensive manual process to perform secondary reviews and ensure HCC codes were complete, accurate, and well supported by clinical documentation.

Apixio provided Capital BlueCross with HCC Identifier, an AI-powered coding and QA application, to streamline second-pass chart reviews. With Apixio’s solution, the team reviewed 33,500 charts more efficiently, increased RAF scores by more than 5% from 2016 to 2018, improved ACA risk corridor performance, and gained greater confidence that submitted codes were supported by the chart evidence.

Capital BlueCross

Andrew Bloschichak

Senior Medical Director, Government Programs