Provider Solutions Make NLP-Enabled Risk Adjustment Coding Part
of Your Business & Care Provider Strategy

Provider Solutions

Talix delivers the most comprehensive NLP enabled Risk Adjustment solution for providers to be able to identify, document, and code risk-adjusted conditions accurately, leading to improved reimbursement accuracy and better care management.  In addition, the flexible Talix Platform addresses the risk adjustment coding needs across medical groups to large health systems.  Our solution serves the end to end needs of providers by covering prospective, concurrent, and retrospective requirements in the risk adjustment coding cycle.  Our suite of NLP-enabled workflow application features allow customers to optimize revenue and resources against a range of risk adjustment business goals and strategies. We are also aware of the shortage of trained risk adjustment coding staff within provider organizations and so we also offer our world-class Virtual Coding service that alleviates the historical patient data review and coding overhead on physicians. This minimizes the administrative burden on physicians and allows them to focus on patient care.

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Application Suite for Providers

Coding InSight

The Coding InSight for Providers workflow application quickly uncovers missed codes and documentation gaps in patient data so coders or providers can process high-value HCC opportunities with increased accuracy and efficiency. This is made possible through our integrated and proprietary healthcare NLP, machine learning, and extensive health taxonomy back-end processing process. Our front-end workflow designs streamline the labor-intensive patient coding process. The result is an end-to-end solution for identifying and submitting accurate HCC codes for any risk-adjusted patient population. 

Prospective Coding Workflow.  With Coding InSight, you can proactively identify high-risk patients, capture miscoded or un-coded diagnoses in patient charts, and quickly close those gaps. With our patent-pending Patient or Member Suspecting logic, we identify patients with suspected HCC codes and rank order patients according to the highest HCC values.  Thus armed, customers can conduct a pre-visit planning and determine which patients require a scheduled in-person visit or whether a telehealth visit would be appropriate to close a care gap.

Concurrent (Point of Care) Workflow.  Once Coding InSight has surfaced suspected HCCs, top-ranked suspected conditions can be presented to the care provider to review and document suspected conditions during the point of care encounter.  Presentation of such conditions can be delivered through technology via the Electronic Health Record, or through our Virtual Coder service.

Retrospective or Post-encounter Review.  Coding InSight’s workflow accommodates post-encounter or retrospective chart review to ensure patient documentation for closed HCC conditions is complete.  Thus, an accurate claims submission can be processed.

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Prospective Suspecting &
Pre-Encounter Review

  • Suspecting & pre-encounter review - analyze patient data to identify patients with suspected HCCs so these patients can be scheduled in for a visit
  • Pre Visit Planning - Coder review of suspected HCC gaps prior to the visit
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Concurrent Point-of-Care
Assessment

  • Surface suspected HCCs to provider at the point-of-care
  • Provider to review and assess suspected conditions and create patient care plan/ documentation
  • These can either be through technology or using our Virtual Coder service
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Retrospective Post-Visit
Review & Coding

  • Review visit note and ensure documentation completeness
  • Ensure accurate coding of HCCs and visit diagnosis codes

Virtual Coder

Talix offers providers a highly trained, flexible resource to complete the coding process at any of the three phases of the Risk Adjustment process.  This NLP-enabled coding service option is called Virtual Coder and can be applied prior to, during, and after the patient encounter.  

 

Talix partners with the world’s finest staff HCC coding organizations, both on-shore and off-shore.  The Virtual Coder is highly proficient in using the Talix coding applications to seamlessly integrate into the customer’s patient care ecosystem.  Our NLP-enabled workflow applications coupled with world-class expert coding resources reduce your cost of operation and time demand on your care providers while delivering accurate results. 

 

Data Integration

For many customers, the layout or arrangement of patient data is complicated and found across many locations, different EHR systems, different versions of an EHR, and so on.  We’ve addressed these challenges both with technology and workflow design.  We know how to incorporate historical patient files, different formats, membership files, claims files, and more into the Talix Platform.  We also partner with the market’s leading data integration experts who bring already configured APIs and data pipes to address your needs.

Powerful Features

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Comprehensive Prospective, Concurrent, & Retrospective Workflow Support

Talix’s powerful data analytics technology delivers a nearly automated method of analyzing vast amounts of structured and unstructured data to identify gaps resulting in better care planning and more accurate claims submissions.  Our workflow designs address the coding continuum from suspecting to claims submission.

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Natural Language Processing (NLP)

Unstructured data represents 80% of newly captured patient information and so it must be understood to address accurate coding and care gap analysis.  NLP coupled with machine learning and deep semantic understanding of health concepts enables care providers to document faster and more accurately once baked into workflow applications that reduce time and cost to process.  Typically, patient data housed in free-text care plans, historical chart notes, and specialist reports holds information that is valuable to the risk adjustment documentation process . By mining this untapped data with advanced analytics, providers obtain the most accurate view of patient risk for improved care planning.  

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Actionable Analytics & Reporting

Gain real-time insight into suspected HCCs, gap closure rates, and performance to better manage the impact from risk adjustment and inform your provider team on how to improve clinical documentation. Coding InSight’s full suite of analytics dashboards delivers near real-time, actionable data that enables administrators and physician leaders to track HCC gap closure progress and financial impact from risk adjustment. Coding InSight also tracks provider coding patterns for improved provider engagement and Clinical Document Improvement (CDI) initiatives. Pre-built modules cover these categories and more:

  • Line of business analytics
  • Provider education analytics
  • HCC gap closure and RAF analytics

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EHR Workflow Integration

‍Thanks to our revolutionary partnership with Nuance, Coding InSight seamlessly integrates directly into the physician workflow across multiple EHRs, including NextGen, Allscripts, Cerner, Epic & Athena health.

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World-Class Customer Success

We work with you through every step of the journey to maximize the value of our risk adjustment platform. From implementation to ongoing account management, our customers receive a robust offering of services to ensure your new strategies are successful. We leverage modern tools and techniques that deliver confidence in achieving your goals.

The Results

Talix solutions provide flexibility and transparency into your coding operations to ensure accuracy, efficiency, and complete claims.

The results are what matter most.  By leveraging advanced technologies and analytics coupled with world-class workflow designs, our customers see astonishing results.

15-20% RAF
19x roi

Close gaps. Improve care.

Advanced Risk Adjustment Solutions for Medicare Advantage, ACA Commercial and Medicare ACO Populations

Save time. Smile more.

Advanced Risk Adjustment Solutions for Medicare Advantage, ACA Commercial and Medicare ACO Populations

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Markets We Serve

Medicare Advantage ACA Commercial

Medicare ACO Medicaid
MIPS/MACRA

The Talix Platform

We built the Talix platform with one goal in mind: to provide powerful, high quality, analytics-driven solutions that enable risk-bearing organizations to gain greater insights and succeed in the age of value-based care. Learn more about our patented technology.