Know which risk dollars would survive a RADV audit
inferonIQ checks every submitted HCC against the chart, values what is at risk with the MMR per-member rate, and confirms your scores match what CMS actually paid.
Every HCC
Checked Against the Chart
Per Member
MMR-Based Dollars
Matches CMS
Scores vs. CMS-Paid
Compliance Report
The problem
Why manual processes leak money and slow your business.
Every contract, every year
CMS announced in 2025 that it will audit every eligible Medicare Advantage contract for each payment year, instead of a small sample.
Errors are extrapolated
Under the 2023 RADV final rule, CMS can extrapolate audit findings across a contract from payment year 2018 onward, so a sample of unsupported HCCs becomes a contract-level repayment.
The chart has to support it
An HCC that was submitted but is not supported in the medical record is deleted in audit, and its payment is recovered.
The solution
How inferonIQ solves each pain point.
Chart evidence for every HCC
AI reads each chart and quotes the exact text and page that supports, or fails to support, each submitted condition (MEAT).
Dollars at risk, per member
Exposure is valued with the member's own MMR monthly rate and segment, including Part D, ESRD and PACE, not a flat average.
Matches CMS
Your computed risk scores are compared with the scores CMS paid on the MMR, member by member, so gaps are explained before an auditor finds them.
MOR reconciliation
The Model Output Report is reconciled into confirmed conditions, RADV exposure and missed revenue.
Coder review & calibration
Coders review findings by default; a nightly calibration measures agreement, and auto-accept is optional and off by default.
Compliance Report
A PDF Compliance Report with the evidence behind each decision, ready for an audit or a board.
Complete workflow
Every step from receipt to payment — fully automated.
Connect
Load charts, the MMR and MOR files, and claims from your EHR (Epic, Oracle Health, FHIR R4, HL7 v2) or by secure file drop.
Read every chart
Each submitted HCC is checked against the chart, with the evidence quoted and the page cited.
Value the exposure
Unsupported conditions are valued with each member's MMR rate and segment.
Check against CMS
Scores are compared with what CMS paid, and the MOR is reconciled.
Review & sign off
Coders confirm or correct findings, provider queries go out for documentation gaps, and the Compliance Report is produced.
Related capabilities
See what we find before you commit.
Read-only connection. We review a sample of your invoices, agreements and supplier spend, then hand back a findings report with specific figures. If there is nothing to recover, there is nothing to pay.