Taking the guess work out of risk-adjusted healthcare.
Continuous Audit: Continuous Insight
Illuminance Insights
Automated Medical Record Evaluation
Unlock vital clinical and financial insights from medical records using state-of-the-art artificial intelligence, interoperability, and analytics technologies.
Pre-Audit Validation
Identify location of best documentation, limit extrapolation exposure and mitigate financial risk.
Pre-audit Validation insights help health plans identify areas of vulnerability and respond effectively and efficiently to payment oversight.
Pre-Submission Evaluation
Identify supported but not reported diagnosis; guide or validate diagnosis submissions.
Pre-submission Evaluation insights help health plans and providers ensure accurate risk adjustments and complete payment for the health conditions of their beneficiary population.
HCC Distribution & Impact
Identify a population’s condition profile, level of documentation support, and payment implication by HCC.
HCC Distribution & Impact insights help health plans understand which HCCs represent particular financial vulnerability and where to focus for the greatest positive impact.
Provider Performance
Identify the top providers contributing to underpayment (under-reporting) and audit/payment recovery risk (under documenting).
Provider Performance insights help health plans monitor provider performance and target specific actions that achieve performance goals through education and outreach.
Medicare Beneficiary Outreach
Educate Medicare beneficiaries through electronic means, providing them with Medicare 101, Q&A’s, Plan Finder, and navigating Parts A, B, C, D benefits.
Leveraging the Illuminance™ platform, Medicare beneficiaries can leverage our My Medicare Buddy™ (MMB) to provide them with how their own PHI can inform their benefit choices.
Streamlined Evaluations
Streamline medical record documentation evaluation.
Waste Reduction
Reduce waste, burden, payment vulnerability and audit liability.
The Illuminance Platform, underpinned by policy-driven algorithms, is designed to put actionable information in the hands of Medicare Advantage Organizations and others focused on achieving the goals of risk-adjusted reimbursement.
Illuminance solutions reduce wasted time and wasted resources by providing precise and tactical guidance to minimize payment vulnerabilities and over- or underpayments.
Leveraging predictive models calibrated against RADV payment policy, Illuminance evaluates the level of completeness of a population’s support documentation, indicating the likelihood regulatory requirements to validate submission of that diagnosis codes have been met.
Illuminance Targeted Insights reports identify the specific providers, beneficiaries and HCCs with the greatest impact on payment, enabling a prioritized focus for education and outreach. Illuminance document scoring identifies gaps between patient encounters and medical record documentation and provides a line-of-sight to documentation most likely to support a submitted or audited Hierarchical Condition Code (HCC).
Secure & Cloud-Enabled AI
The Illuminance Technology Platform is engineered in the cloud for massive scalability and efficiency, and hosted in a HIPAA compliant, HITRUST certified environment for reliable security and compliance. Powered by deep learning models and natural language processing (NLP), our automation technology is able to interpret complex medical records
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