Case Study: Sigma Healthcare achieves 98.5% coding accuracy and strong ROI with Apixio HCC Identifier

Sigma Healthcare - Customer Case Study

Sigma Healthcare, a large Medicare Advantage health plan with about 100,000 lives, needed to improve risk score accuracy and support retrospective chart reviews across both employed and independent provider groups. The organization ran a 5-week pilot with Apixio to evaluate first-pass chart review performance and the ability to surface supported HCC codes quickly and accurately.

Apixio implemented its HCC Identifier for first- and second-pass chart reviews, processing EHR and PDF charts and aligning coding guidelines with Sigma’s standards. The solution delivered 983 new supported HCC codes and 177 potential deletes in under 12 weeks, with Sigma auditing and agreeing with 98.5% of the new codes and 72% of the potential deletes, showing strong ROI, high accuracy, and faster turnaround than a manual-only approach.

Sigma Healthcare