Electronic Health Reporter

Talix, Inc., a premier provider of healthcare risk management solutions, today launched Coding InSight for Payers, the latest version of its Coding InSight risk adjustment application. Designed specifically for health plans, Coding InSight for Payers helps health plans automate and streamline risk adjustment processes for Medicare Advantage and Commercial Exchange members by effectively uncovering missed HCC (Hierarchical Condition Category) codes in member charts, closing coding gaps, and improving coding accuracy and efficiency.

Powered by the Talix HealthData Engine, Coding InSight for Payers combines advanced natural language processing (NLP) technology, sophisticated clinical rules and a proprietary medical taxonomy to analyze member data from disparate sources, such as claims, electronic medical records and scanned paper documents, to accurately identify missed coding opportunities. As a result, professional coders at health plans can uncover more missed HCC conditions and documentation gaps, increase coding efficiency and increase productivity.

Key features of the new Coding InSight for Payers application include:

• Unified Coder Workspace – Coding InSight for Payers features an intuitive yet powerful workspace, designed specifically for high throughput coding departments. It brings together all relevant clinical and financial member data, along with necessary functionality required for coders and auditors to accurately reconcile codes. The solution is fully integrated and designed to support varied workflows with customizable worklists.
• Automated Suspect Identification – Coding InSight for Payers streamlines the highly manual and time-consuming chart review process. By leveraging the rich Talix Taxonomy, clinical rules database and proprietary NLP technology, the application mines both structured and unstructured member data — including free-text care plans, historical chart notes and specialist reports — to automatically hone in on missed codes and documentation gaps.
• Analytics and Reporting – A comprehensive suite of dashboards and reports deliver real-time, actionable data, enabling administrators to track coder productivity, financial impact from risk adjustment, and provider coding patterns to assist in provider outreach and clinical documentation improvement initiatives.
• Multi-Factor Auditing Capabilities – Coding InSight for Payers goes beyond just identifying coding gaps by presenting coders with specific evidence in the member’s record to support the recommended codes. Coders are able to expedite the reconciliation process and have a clear line of sight between claimed codes and supporting documentation in case of an audit, resulting in improved audit confidence and decreased compliance risk.

“The manual coding process is time-intensive and often costly, which presents a tremendous pain point for many health plans around the country as they shift to value-based care models,” said Dean Stephens, CEO of Talix. “Automating and streamlining this laborious process has a big impact on coder productivity and accuracy, resulting in much-needed cost savings. Talix has been helping provider organizations through our Coding InSight for Providers application to improve patient risk scoring and outcomes, and we’re excited to now roll out Coding InSight for Payers to help health plans achieve the same results.”

Talix is showcasing Coding InSight for Payers at Booth 72 at the 2016 RISE Nashville Summit taking place March 20-22. To see a demo of the product, visit the Talix booth or contact info@talix.com to schedule a demo.

About Talix
Talix provides healthcare risk management solutions to help providers, payers and accountable care organizations address the challenges of value-based healthcare and risk-based contracts. Its SaaS applications leverage patient data analytics to turn structured and unstructured health data into actionable insights that drive improved risk adjustment, better patient outcomes and reduced costs. For more information, please visit www.talix.com or follow @TalixHealth on Twitter.