Nationwide chart retrieval + AI risk adjustment in one HIPAA-tight platform. 95% chart hit-rate in <48 hours with 0.34 average RAF lift and 22% lower chart-chase spend vs. legacy vendors.
Chasing charts with faxes and phone calls torches margin.
Coders burn hours re-indexing PDFs no one named the same way twice.
Missed HCCs = millions left on the table come reconciliation.
CMS auditors want iron-clad provenance on every diagnosis code.
One API taps 85% of U.S. providers and 99% of hospitals.
AI auto-extracts HCC evidence and bundles coder-ready packets.
Fully auditable—from provider signature to CMS IDR upload.
SOC 2 Type II + HIPAA + MFA at every touchpoint.
Four core capabilities that transform your risk adjustment operations from manual chaos to automated efficiency.
Pulls clinical data (CCDAs, progress notes, imaging, labs) based on your eligibility file—no member portals required.
Flags time-bound conditions and co-morbidities you're probably missing.
Pre-tags diagnoses, shows dates of service, and tracks coder throughput live.
Pushes final codes to your risk engine in FHIR or flat-file format.
Real performance benchmarks from Medicare Advantage plans using Simpl Healthcare.
Less back-and-forth with providers means faster RAF capture.
Cleaner evidence packets mean smoother RADV or OIG audits.
Higher RAF + lower retrieval cost = serious boost to loss ratio.
Enterprise-grade data highways and zero-trust security architecture that keeps your data flowing securely.
4-week implementation with measurable ROI from day one.
Swap SFTP keys, white-list IPs, map your eligibility schema.
Pull 500 test charts; validate coverage, file mapping, and audit logs.
Real members, real retrieval, side-by-side coder accuracy check.
All MA lines turned on, automated nightly runs, dashboard access for actuaries and coding leads.
Join Medicare Advantage plans nationwide that have boosted RAF scores, reduced retrieval costs, and improved actuarial outcomes with Simpl Healthcare.