Healthcare
Health Plans & Payers
Risk-adjustment and chart-review partners who make your RAF scores accurate, your payments right, and your program audit-ready.
Reviewed for clinical and coding accuracy by Zyphercode’s AHIMA- and AAPC-certified coding leadership.
RADV
Audit ready
99%+
Review accuracy
100%
Compliant
Overview
Health plans operate under intense accuracy and compliance demands. Our CRC-certified teams perform high-volume retrospective and prospective chart reviews that capture every supported condition while protecting you from unsupported coding.
We pair coding depth with suspect analytics and RADV audit readiness, so your member acuity is fully and defensibly represented.
What we deliver
Capabilities built for results
HCC capture
Complete, compliant capture across CMS-HCC and HHS-HCC models.
Chart reviews
Scalable retrospective and prospective review programs.
Suspect analytics
Identify likely undocumented conditions and close gaps.
RADV readiness
Documentation that withstands CMS validation audits.
Why Zyphercode
The outcomes you can expect
We pair specialized expertise with disciplined delivery and transparent reporting — so the value shows up in your numbers, not just in a deck.
Schedule a conversation- Accurate RAF scores and capitation
- Reduced over-coding and compliance risk
- High-volume review capacity on demand
- Closed care and documentation gaps
- Audit-ready trails and reporting
- HIPAA-compliant data handling
FAQ
Common questions
What is HCC capture for health plans?
HCC capture is the complete, compliant coding of members' chronic and serious conditions across the CMS-HCC and HHS-HCC models so RAF scores reflect true member acuity.
Are your chart reviews RADV-ready?
Yes. Our retrospective and prospective reviews are documented to withstand CMS RADV validation audits.
Can you scale for AEP and sweeps?
Yes. We provide high-volume retrospective and prospective review capacity on demand for AEP and sweep periods.
Ready to get started with Health Plans & Payers?
Let's talk about your goals and how Zyphercode can deliver measurable results.
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