Case Study: a mid-sized health plan improves coding accuracy and risk adjustment with Zymr's AI-powered predictive CDS

a mid-sized health plan improves coding accuracy to 91% with Zymr

The client, a mid-sized health plan, faced challenges with inaccurate medical coding and missed risk adjustment opportunities, which created financial losses and operational inefficiencies across its provider networks. To address this, the health plan partnered with vendor Zymr to implement an AI-powered predictive clinical decision support (CDS) solution.

Zymr developed and deployed an AI-driven revenue cycle intelligence platform that integrated predictive analytics to identify under-coded encounters and provide real-time coding prompts. This solution achieved a 91% prediction accuracy across millions of claims and recovered tens of millions in missed revenue opportunities for the client.