RiskGen-i: Risk Adjustment, Reimagined

Clinical data lives everywhere. Conditions get missed. RAF scores drift. And every undocumented diagnosis creates compliance risk and lost revenue.

RiskGen-i brings AI-powered risk adjustment together with clinical validation to transform medical record review into accurate HCC coding, complete documentation, and audit-ready risk scores – fast, defensible, and scalable.

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The Risk Adjustment Bottleneck

Even experienced teams face increasing complexity in risk adjustment. Fragmented data, inconsistent documentation, and evolving regulations make HCC coding, RAF accuracy, and encounter data submission increasingly challenging – slowing workflows, increasing audit risk, and highlighting the need for AI-driven risk adjustment solutions.

Incomplete HCC Condition Capture

Many chronic conditions remain undocumented or uncoded, causing missed RAF opportunities and revenue gaps.

Complex Multi-Source Data Streams

Large volumes of structured and unstructured clinical data challenge efficient HCC coding and accurate RAF reconciliation.

RAF Accuracy & Validation Challenges

Inconsistent or incomplete documentation leads to RAF discrepancies, increasing audit exposure and compliance risk.

Limited Visibility Into Care Gaps

Without real-time insights into HEDIS or clinical documentation gaps, proactive risk and quality management suffers.

Introducing RiskGen-i: AI-Powered Risk Adjustment, Reimagined

RiskGen-i combines neuro-symbolic generative AI with clinical oversight to transform healthcare risk adjustment. Designed for payers, provider groups, and care networks, it accelerates AI medical record review, strengthens HCC coding accuracy, and ensures defensible RAF optimization – all while enhancing quality, compliance, and revenue integrity.

HCC Condition Detection

RiskGen-i’s AI scans unstructured clinical notes to identify potential HCCs that may be missing or under-documented. Coders review flagged conditions confidently, enabling earlier capture of chronic conditions and reducing missed-risk opportunities.

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AI-Powered HCC Coding

The AI engine recommends precise ICD/HCC codes aligned with CMS risk adjustment guidelines and MEAT/TAMPER criteria. It streamlines coding workflows while ensuring compliance and evidence-backed code assignment.

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HCC Condition Detection

AI-Powered HCC Coding

RAF Score Validation

Predictive Analytics Dashboard

HEDIS & Care Gap Insights

Documentation Improvement

How RiskGen-i Works

RiskGen-i delivers an integrated, AI-powered workflow combining predictive analytics with certified risk coders. This ensures AI medical record review is actionable, compliant, and embedded into risk adjustment workflows. Here’s how it works:

Record Ingestion

Connects to EHRs or ingests medical records to process structured and unstructured records efficiently.

Suspect Flagging

Neuro-symbolic AI identifies potential HCCs, comorbidities, and documentation gaps.

Human Validation

Certified risk coders review flagged HCCs, ensuring accuracy, compliance, and clinical governance.

Risk Reporting

Validated results reconcile RAF scores and populate real-time analytics dashboards.

The 3Gen Difference

AI Innovation Backed by Human Expertise and Governance

With RiskGen-i, you don’t just get AI in risk adjustment – you gain a partner in precision. At 3Gen, we combine leading-edge AI with clinical rigor, human expertise, and enterprise-grade governance to deliver risk solutions that are accurate, auditable, and scalable.

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Measurable Risk Adjustment Impact

RiskGen-i delivers measurable improvements in risk adjustment, HCC coding accuracy, and operational efficiency. Results vary by client, but benchmark data shows significant gains.

XProductivity Increase

%+HCC Coding Accuracy

%+Chart Retrieval Rates

:1Return on Investment

The 3Gen Advantage

RiskGen-i combines AI in risk adjustment with human validation to deliver scalable, compliant, and consistently audit-ready solutions. Here’s what sets 3Gen Consulting apart.

Clinically Defensible

AI medical record review flags HCCs traceable to source documentation, ensuring audit-ready accuracy.

Scalable Workflows

Automated prioritization processes high chart volumes without sacrificing a certified coder’s review.

Regulatory Compliance

Built-in oversight and compliance reduce RADV audit risk and support CMS adherence for every HCC.

Cost Reduction

AI workflows reduce repetitive tasks, letting coders focus on high-value, revenue-generating work.

Proactive Insights

Predictive dashboards identify high-risk members and care gaps for timely interventions.

Adaptive Learning

System improves continuously by learning from certified risk coder validation and clinical feedback.

Built on Trust. Backed by
Global Compliance.

Ready To See RiskGen-i In Action?

Get a demo to see how RiskGen-i optimizes AI medical record review and HCC coding.

Connect with our experts to:

Automate risk adjustment workflows
Enhance accuracy and regulatory compliance
Accelerate financial performance

FAQs

Get clear answers to common questions about AI-powered risk adjustment, HCC coding accuracy, and predictive risk management with RiskGen-i.

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RiskGen-i uses clinically trained neuro-symbolic generative AI models and shows the source text for every suggestion. Certified risk coders validate each suspect HCC, ensuring compliance with coding guidelines and MEAT/TAMPER criteria.

Yes – RiskGen-i supports ingestion of structured and unstructured data, including notes, labs, scanned records, and more, through flexible integration options.

It automatically reconciles predicted versus submitted RAF scores, identifying discrepancies to prevent revenue loss and compliance risk.

Yes, predictive dashboards highlight preventive and chronic care gaps, enabling proactive interventions to improve quality and compliance metrics.

Scalable AI workflows, coupled with certified coder validation, manage high chart volumes efficiently across MA, ACO, and PACE programs.

3Gen combines RiskGen-i’s AI precision with clinical expertise, compliance oversight, and measurable ROI, making us a trusted partner.