Change Healthcare and Health Fidelity Partner to Increase Quality and Accuracy of Risk Adjustment Coding

NASHVILLE, Tenn.–(BUSINESS WIRE)–Change Healthcare today announced that it is collaborating with Health
, Inc. to offer a risk adjustment solution that embeds
natural language processing (NLP) and machine learning technology into
its risk adjustment coding offering to help Medicare Advantage, ACA
commercial, and Medicaid payers increase claim accuracy and better
address compliance obligations.

In today’s value-based environment, health plans are under mounting
pressure to submit well-supported codes, and the cost of non-compliance
can be substantial. However, risk adjustment remains a predominantly
manual and tedious process in which coding specialists review records
for unreported risk conditions. Now, leveraging Health Fidelity’s NLP
technology, coders will be better able to prioritize and review charts
with greater accuracy and compliance.

“Risk adjustment requires a high level of clinical data acquisition and
careful analysis of millions of medical records to assign the proper
diagnosis code to claims,” said Doug Duskin, senior vice president and
general manager, Clinical Review, Change Healthcare. “Health Fidelity’s
NLP engine has demonstrated very high sensitivity in identifying ICD and
HCC codes, enabling their clients to realize a 20-30% increase in risk
capture. This added capability is exciting as we expect it will lead to
better gap closure and improved quality of care and outcomes for

Change Healthcare offers Risk Adjustment Coding for payers that need
accurate supporting data from member medical records to drive and help
improve risk scores. Health Fidelity’s technology is a natural
complement to these services and offers customers a highly flexible
solution that can be tailored to their requirements, surround the
problem, and deliver high-quality coding.

“With their scale, established payer relationships, and years of coding
experience, Change Healthcare is the ideal partner to extend the reach
of our natural language processing within risk-adjustment coding,” said
Steve Whitehurst, Health Fidelity CEO. “The resulting combination of
analytics, artificial intelligence, and services allows us to customize
our solutions to meet customer goals and improve overall performance and

The combined Change Healthcare–Health Fidelity offering represents a
single enterprise solution covering analytics (identifying which medical
charts to examine for which patients), chart retrieval, coding, and
submission. The application of NLP technology during the coding phase
provides greater accuracy, which in turn translates to better compliance
and more precise reimbursement.

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About Health Fidelity

Health Fidelity delivers comprehensive, scalable risk adjustment
solutions for risk-bearing entities that participate in Medicare
Advantage, ACA, Medicaid, and Medicare ACO programs. With a combination
of big data analytics and natural language processing (NLP) technology,
Health Fidelity’s modern prospective and retrospective risk adjustment
approaches extract valuable insights from medical records, changing the
way risk is identified, quantified, and managed for enhanced
operational, clinical, and financial outcomes. Learn more at

About Change Healthcare

Change Healthcare is inspiring a better healthcare system. Working
alongside our customers and partners, we leverage our software and
analytics, network solutions, and technology-enabled services to enable
better patient care, choice, and outcomes at scale. As a key catalyst of
a value-based healthcare system, we are accelerating the journey toward
improved lives and healthier communities. Learn more at