This fact sheet details IQVIA’s NLP Risk Adjustment Solution, which automates the identification and coding of HCC and ICD10-CM conditions to improve reimbursement accuracy and reduce compliance risk. By leveraging NLP and clinical intelligence, it captures 97% of conditions with over 90% precision and recall, reducing manual review time and costs. The system prioritizes workflows, offers interactive coding interfaces, and provides audit trails for CMS submissions. A case study of a large U.S. payer shows improved efficiency and accuracy, identifying more diagnoses and supporting population health initiatives while ensuring scalable, accountable risk adjustment.

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