Case Study: Capital Blue Cross Improves Risk Adjustment Accuracy and RAF Scores with Apixio HCC Identifier

MagnaCare - Customer Case Study

Magnacare, a health plan managing risk adjustment across government programs, faced a labor-intensive challenge reviewing first-pass coding for Medicare Advantage and ACA members. Their small team needed a more efficient way to identify missing HCC codes and potential deletes while ensuring every submission was accurate and well supported. To help with this, they worked with Apixio and its HCC Identifier, an AI-powered coding and QA application.

Apixio implemented HCC Identifier to support second-pass chart reviews alongside Magnacare’s internal coders, allowing the team to pinpoint the exact documentation needed for coding decisions and reduce manual review time. The result was more efficient QA, greater confidence in coding accuracy, and a measurable improvement in risk outcomes, including a 5% increase in RAF scores over two years and better risk capture for ACA plans.

Magnacare