Deterministic ICD-10-CM Audit Engine
for HCC Validation & RADV Defense

A second-pass audit layer that standardizes coding decisions,
reduces unsupported HCCs, and protects you from RADV risk —
without replacing reviewers or changing workflows.

Discuss Audit Integration Request a Pilot

Enterprise B2B Solution   |   Batch + API Integration

This is not autonomous coding.

This is an explainable compliance engine designed for audit organizations operating at scale.

Built to Fit Into Mature Audit Operations

We validate decisions already made — enforcing ICD-10-CM and HCC rules consistently, every time.

📄

Provider
Documentation

→
👤

Human
Coding

→
🔍

Human Audit /
Review

→
🛡️

Falcon Coding
(2nd Pass)

→
✅

Client Delivery /
MA Plan / CMS

What We Do — and What We Don't

What We Do

  • Validate ICD-10-CM & HCC logic using deterministic rules
  • Enforce official guidelines (not probabilities)
  • Flag unsupported or inconsistent diagnoses
  • Produce PASS / FAIL decisions with audit-ready reasoning
  • Standardize reviewer decisions at scale

What We Don't Do

  • We do not auto-code
  • We do not replace coders or auditors
  • We do not inflate RAF scores
  • We do not operate as a black box

Designed for Coding & Audit Organizations

This platform is purpose-built for organizations with audit responsibility and RADV exposure.

Target Organizations

  • Coding & Audit Firms
  • Risk Adjustment Vendors
  • RCM Platforms with audit responsibility
  • Organizations exposed to RADV audits

Core Problems We Solve

  • Reviewer-to-reviewer inconsistency
  • Over-conservative vs over-aggressive coding
  • Unsupported HCCs passing internal QA
  • Lack of explainable audit trails during RADV

Key Capabilities

Deterministic Rule Engine

ICD-10-CM and HCC logic enforced as rules, not predictions.

Explainable Decisions

Every outcome includes triggered guideline, missing evidence, and audit-ready reasoning.

Second-Pass Validation

Works after human review, before results leave your organization.

RADV-Ready Output

Structured reasoning designed for retrospective audits and compliance review.

We don't help you code faster.
We help you make the same defensible decision — every time — at scale.

Start With a Low-Risk Pilot

Test the engine on your highest-risk domains before full integration.

Pilot Structure:

  • 30–60 days
  • Limited chart volume
  • No workflow disruption
  • Focus on high-risk domains: Diabetes, Sepsis, CHF, CKD

Expected Outcome:

Clear insight into:

  • Decision consistency
  • Unsupported diagnosis exposure
  • Audit defensibility
Request a Pilot Conversation

In an environment where CMS audits decisions years later,
explainability and consistency matter more than automation.

This platform exists to be your audit logic firewall —
protecting your organization, your clients, and your reputation.