Cybexys, Inc

CYBEXYS’s expert system CARAT™ uses Artificial Intelligence to capture the most accurate diagnostic codes supported by the provider’s clinical documentation, to factor the Risk Score that determines the amount the Federal and State governments pay Medicare Advantage plans, MSOs. ACOs and Medicaid plans; as well as the Risk Adjustment applied to health plans participating in the ACA Marketplace. Systemic poor documentation and coding by providers cause erroneous Risk Scores resulting in underpayment and misallocation of funds of tens of Billions of dollars per year. CARAT prevents these losses by showing the documentation and coding omissions in real-time concurrent with each provider-patient encounter allowing providers and health plans to correct the errors prospectively. CARAT also automates retrospective reviews reducing the need for costly manual labor incurred by health plans, ACOs, MCOs and providers.