TLDR: RAAPID has launched its innovative AI-powered RADV Audit Solution at RISE West 2025, designed to help health plans navigate the Centers for Medicare & Medicaid Services’ (CMS) stringent Risk Adjustment Data Validation (RADV) audits. The solution leverages neuro-symbolic AI for automated chart review, accurate HCC code validation, and comprehensive audit management, aiming to mitigate significant financial risks posed by CMS’s expanded audit scope and extrapolation methodology.
LOUISVILLE, Ky. – RAAPID, a prominent provider of AI-driven risk adjustment and compliance solutions, has officially unveiled its comprehensive RAAPID RADV Audit Solution at the RISE West 2025 conference. This industry-first offering is specifically engineered to empower health plans in confidently addressing the Centers for Medicare & Medicaid Services’ (CMS) increasingly rigorous Risk Adjustment Data Validation (RADV) audits. The solution became available on August 26, 2025, with early adopters receiving priority support and direct access to RAAPID’s RADV experts .
The launch comes at a critical time, as CMS projects $4.7 billion in RADV recoveries and has implemented universal annual audits, significantly escalating financial risks for health plans. The new audit framework demands impeccable documentation and zero coding errors, a standard nearly impossible to achieve through traditional manual processes alone. The 2023 CMS Final Rule introduced contract-level extrapolation, meaning error rates found in a sample are now projected across the entire audited Medicare Advantage (MA) contract, transforming minor documentation lapses into substantial financial liabilities . CMS also plans to expand audits from 60 to approximately 550 MA plans annually, reviewing 35 to 200 records per plan, and increasing its coder staff from 40 to 2,000 by September 1 .
RAAPID’s solution integrates advanced technology with expert knowledge to provide end-to-end RADV audit management. Key features demonstrated at RISE West include: * Real-time Audit Workflow Management: A centralized, intelligent console eliminates reliance on spreadsheets, offering automated alerts and progress tracking for all audit activities . * AI-Powered Chart Review: The platform’s neuro-symbolic AI instantly analyzes medical charts, accurately identifies HCC codes, and generates explainable evidence trails that withstand CMS scrutiny . * Mock Audit Simulation: Health plans can experience a compressed timeline of an actual RADV audit cycle, from initial notification to final response submission, to proactively identify documentation gaps .
Chetan Parikh, CEO of RAAPID, emphasized the solution’s impact: “At RISE West, we’re not just talking about AI – we’re showing exactly how it solves healthcare’s most expensive compliance challenge. Attendees will see our platform process actual de-identified charts, validate HCC codes, and generate audit-ready documentation in minutes, not months.” He added, “The gap between feeling prepared and being truly audit-bulletproof has never been more costly. Our AI-powered solutions eliminate the chaos of manual processes and deliver the continuous audit readiness that health plans desperately need to protect their revenue” .
RAAPID’s platform has a proven track record, helping healthcare organizations achieve over 98% coding accuracy and reducing chart review time by 60% to 80% . The company’s HITRUST-certified platform ensures complete data protection, meeting all enterprise security requirements including HIPAA, SOC2 Type II, and HITRUST certifications .
RAAPID develops AI-powered risk adjustment solutions for healthcare payers, providers, and supporting organizations. Its neuro-symbolic AI identifies chronic conditions, determines HCC codes, calculates risk scores, and analyzes population health trends. Following a Series A investment from M12 (Microsoft’s venture fund), RAAPID serves organizations in Medicare Advantage, ACA, Medicare ACO, and Medicaid programs. The company is headquartered in Louisville, Kentucky .
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At RISE West 2025, RAAPID also hosted an exclusive roundtable titled “Audit-Ready Always: How to Build a Future-Proof RADV Strategy,” featuring industry experts like Michael Clark, Yaw Asante, David B. Rosenfeld, and Chris Gluhak. The discussion focused on leveraging former RADV auditor insights, moving beyond manual processes with AI-powered software, and building continuous audit readiness .
