Zero-Chase Medical Records. Bigger RAF. Happier Actuaries.
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.
Pain Points That Torch Your Margin
Chart Chase Burns Margin
Chasing charts with faxes and phone calls torches margin.
Coder Inefficiency
Coders burn hours re-indexing PDFs no one named the same way twice.
Missed HCCs
Missed HCCs = millions left on the table come reconciliation.
Audit Vulnerability
CMS auditors want iron-clad provenance on every diagnosis code.
How Simpl Delivers ROI
Nationwide Provider Network
One API taps 85% of U.S. providers and 99% of hospitals.
AI-Powered Extraction
AI auto-extracts HCC evidence and bundles coder-ready packets.
Fully Auditable
Fully auditable—from provider signature to CMS IDR upload.
Enterprise Security
SOC 2 Type II + HIPAA + MFA at every touchpoint.
Risk Adjustment That Actually Works
Four core capabilities that transform your risk adjustment operations from manual chaos to automated efficiency.
Smart Retrieval Engine
Pulls clinical data (CCDAs, progress notes, imaging, labs) based on your eligibility file—no member portals required.
HCC Suspect Logic
Flags time-bound conditions and co-morbidities you're probably missing.
Coder Workbench
Pre-tags diagnoses, shows dates of service, and tracks coder throughput live.
One-Click Export
Pushes final codes to your risk engine in FHIR or flat-file format.
Deeper Metrics That Matter
Real performance benchmarks from Medicare Advantage plans using Simpl Healthcare.
Why These Metrics Matter
Faster RAF Capture
Less back-and-forth with providers means faster RAF capture.
Smoother Audits
Cleaner evidence packets mean smoother RADV or OIG audits.
Better Loss Ratio
Higher RAF + lower retrieval cost = serious boost to loss ratio.
Interoperability & Security Built Right
Enterprise-grade data highways and zero-trust security architecture that keeps your data flowing securely.
Data Highways
Security Posture
Implementation & ROI
4-week implementation with measurable ROI from day one.
How We Roll You Out
Kick-Off
Week 0Swap SFTP keys, white-list IPs, map your eligibility schema.
Sandbox Live
Week 1Pull 500 test charts; validate coverage, file mapping, and audit logs.
Pilot Cohort
Week 2-3Real members, real retrieval, side-by-side coder accuracy check.
Full Launch
Week 4All MA lines turned on, automated nightly runs, dashboard access for actuaries and coding leads.
ROI Snapshot
Ready to Transform Your Risk Adjustment?
Join Medicare Advantage plans nationwide that have boosted RAF scores, reduced retrieval costs, and improved actuarial outcomes with Simpl Healthcare.