Case Study: Major Regional Health Organization achieves $1.2M in additional reimbursement with Talix Coding InSight

Major Regional Health Plan Gains12X ROI and $1.2 Million in Additional Reimbursement Revenue with Talix’s 2nd Level Chart Review

Major Regional Health Organization, a major regional health plan serving Medicare Advantage and ACA members, wanted to improve risk adjustment accuracy and reduce exposure by adding a second-level chart review process. The organization had previously relied on outside vendors, but high costs and limited visibility into QA made it difficult to maintain quality and control, so it turned to Talix and its Coding InSight platform.

Talix implemented Coding InSight to automate and streamline second-level chart review, helping the health plan bring coding back in-house and improve workflow, visibility, and productivity. The project identified 2,400 additional HCC codes across 10,000 patient charts, generated $1.2 million in additional reimbursement, increased coder productivity from 3–4 charts per hour to 9–12, and delivered a 12X ROI.