RADV Audit Defense - Proactively Prepare, Validate, and Defend HCC Submissions
Built on D4RADV's proprietary intelligence engine, our platform performs member-level validation across ehr medical records with full MEAT compliance, ensuring that every HCC submitted is clinically supported and defensible during a radv audit.
As healthcare and digital transformation accelerates, D4RADV combines AI-powered validation with a fully integrated coder and auditor workflow, enabling continuous audit readiness at scale.
RADV audits have become a year-round operational priority. Automate chart review, evidence validation, and HCC reconciliation efficiently.
Identify documentation gaps early and generate audit-ready outputs at scale — before CMS auditors do.
Audit Defense Capabilities
Diagnosis Code Detection
+99% accuracy for mapping diagnoses codes to the correct HCC
Unlimited RADV Projects
Create as many CMS or Mock RADV audit projects as you like. Complete control of chart volume and system throughput.
Productivity Improvement
Realize up to 70% time reduction on each RADV project with automated setup, collaborative workflows and improved accuracy.
Per Chart Value Uplift
Expect >45% increase in chart value. AI assists by confirming diagnoses, flagging under-coded conditions and suggesting missed conditions.
The Challenge
Why RADV Readiness Matters
RADV audit scope and rigor continue to increase - making it essential to ensure each submitted HCC is supported by complete, defensible documentation and clear traceability.
Common pain points we solve:
Manual chart review that doesn't scale
Difficulty proving clinical evidence sufficiency
Inconsistent validation of documentation standards (e.g., MEAT gaps)
Risk of recoupments due to unsupported diagnoses
How It Works
Ingest
Charts & coded diagnoses at scale
AI Review
NLP/LLM documentation gap analysis
Risk Scoring
HCC evidence packs & prioritization
Audit-Ready
Mock audits & CMS submission
Our Solution
What Our RADV Solution Delivers
A modern RADV audit readiness platform that helps you find issues before auditors do, automate evidence packets, and strengthen defensibility.
Automated Chart Review
Automated chart review and evidence validation to detect missing or non-defensible documentation at scale.
HCC Coding Reconciliation
Identify gaps and discrepancies between clinical documentation and HCC submissions before auditors find them.
Audit Scoring & Benchmarking
Audit-readiness reporting mapped to CMS criteria with cohort-level benchmarks for proactive risk management.
Evidence Packs
Explainable evidence packs and audit-ready reports to support review prioritization and audit defense.
MEAT Validation
Documentation gap detection including unsupported diagnoses and missing MEAT (Monitor, Evaluate, Assess, Treat) evidence.
Secure Deployment
Customer-controlled deployment (containerized) with HIPAA-aligned processing to maintain PHI control.
Process
How It Works
A simple, executive view of our RADV readiness workflow.
Ingest
Ingest charts and coded diagnoses from your environment at scale.
AI Review
AI reviews documentation using healthcare-trained NLP/LLMs to flag gaps.
Risk Scoring
Generate risk scoring and evidence packs so teams focus where it matters.
Audit-Ready
Produce audit-ready outputs supporting mock audits and CMS readiness.
Target Audience
Who It's For
Built for organizations operating in high-compliance risk adjustment environments.
Medicare Advantage Organizations
Risk Adjustment & Coding Teams
ACOs
Audit & Compliance Teams
Results
Outcomes You Can Expect
Reduced Exposure
Identify documentation gaps and unsupported diagnoses prior to audit submission.
Less Manual Effort
Automated review and evidence packet generation at scale.
Improved Defensibility
Explainable evidence packs, scoring, and audit-ready reporting.
Scalable Readiness
Support internal mock audits and ongoing monitoring workflows.