NLP—Just Another Acronym in the Healthcare Alphabet Soup?

The Value of NLP Powered Risk Adjustment

Everyone knows Cozeva identifies members with potential suspects and care gaps and presents them to the provider, prompting them to take action. But did you know Cozeva also uses Natural Language Processing (NLP) to read through the structured and unstructured charts, to greatly benefit retrospective chart reviews? NLP is like having another set of eyes (with 20/20 vision) to catch codes the reviewer did not see or pay attention to because they were tired from looking at charts all day. NLP allows for completeness of coding to ensure that you have extracted all the codes documented in the chart, unlocking the most value.

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NLP is not just another acronym in the convoluted healthcare alphabet soup, as a second-level review it leads to a more complete understanding of members’ risk profiles without additional provider contact and abrasion which lessens administrative demands. It also complements existing coding efforts to bring higher confidence in the integrity of the risk adjustment program. NLP helps eliminate any possible upcoding by highlighting the lack of substantiating evidence (MEAT) of a selected condition, mitigating the chance of RAD-V audit. The benefits are not just for the risk adjustment programs, quality teams can pick up data from the chart as well especially when chart chasing prospectively e.g. Annual Wellness Visits which can be customized and completed within Cozeva.

NLP leads to greater accuracy when combined with the manual efforts of the coder and there are many use cases for it. Request a demo to see how Cozeva uses NLP to streamline the compliance & auditing process, manage risk scores, and increase claim accuracy.