- Pre-visit Condition Capture
- Clinical Indicator Review
- RAF & HCC Integrity
Catch Risk Early — Before the Encounter
Our concurrent review teams perform structured HCC validation, documentation checks, coding review, and clinical condition assessment during or immediately after patient encounters. This ensures diagnoses are captured correctly, supported with compliant documentation, and prepared for accurate submission — eliminating costly retroactive corrections.
Our Concurrent Risk Review Services
Real-Time HCC Identification
Detect and validate HCC-relevant conditions while providers are still charting or before claim closure.
Documentation Sufficiency Checks
Evaluate whether medical records meet compliance requirements for risk-adjustable conditions.
Concurrent Coding Review
Review diagnosis codes, reduce unsupported conditions, and avoid downstream correction cycles.
Care-Gap Detection
Identify missing assessments, follow-up needs, or chronic conditions lacking documentation.
Provider Feedback Reports
Deliver concise summaries to help clinicians improve documentation quality and accuracy.
Submission Readiness Validation
Ensure all risk-impacting diagnoses are validated before claim submission to prevent revenue loss.
Let's Start Today.
Our Concurrent Review Workflow
Our approach follows a structured, repeatable process designed to validate risk data early. This prevents downstream errors, improves RAF accuracy, and enables cleaner submissions — reducing compliance risks and enhancing plan performance.
Encounter Data Intake
Receive clinical notes, charts, vitals, and encounter records in near real time.
Encounter Data Intake:
Cross-check documented conditions with clinical indicators and history.
HCC Mapping & Validation
Apply appropriate HCC models and validate support for risk-adjustable codes.
Documentation Gap Detection
Identify missing elements needed to support diagnoses (MEAT/TAMPER).
Provider Notification
Provide structured feedback to clinicians for documentation improvement.
Submission Readiness
Mark encounters as complete and validated for downstream claim submission.
Speak With an Expert
Improve Your Operational Outcomes. Connect with us today for a no-charge in-depth Consultation before we begin optimizing your operations.
Schedule a Free Consultation
By submitting this form you agree to our Privacy Policy. Optimum may contact you via email or phone for scheduling or marketing purposes.