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AI-enabled risk adjustment

Artificial intelligence (AI) enables a smarter, highly efficient chart review process while maintaining coding accuracy and completeness. 


Transforming the risk adjustment process

Millions of medical charts are retrieved and reviewed manually each year to generate a more complete picture of member health status. Traditional retro risk processes lacked the technology and tools to precisely identify charts that support unreported diagnosis codes.

The result has been a less efficient process that can disrupt providers by requesting more medical charts than necessary. 

Optum uses artificial intelligence (AI) enabled by our experience with the largest database of Medicare Advantage medical records in the industry, as well as Affordable Care Act (ACA) and Medicaid medical records, to optimize the retrospective risk adjustment process.

An AI-enabled comprehensive solution

Our comprehensive solution enables a smarter, highly efficient chart retrieval and review process. Optum AI-enabled analytics can transform your chart review operations due to its accuracy when trained with large amounts of data. 

AI modernizes the traditional chart review process by shifting the focus from volume to precision targeting of charts. The result is fewer chart retrieval requests, which lowers provider abrasion and increases the efficiency of each review. AI also helps the chart review process to be more precise when capturing suspected but unreported diagnosis codes.





Optum smart chart targeting analytics consistently exclude 3% or more zero chart values*



More than 2 million medical charts retrieved by Optum in 2021 for risk adjustment using digital access



Optum AI has enabled a 5-7% increase in validation rates in our internal QA oversight process

*Amount impacted by health plan targeting preferences. Your results may be greater or lower based on your targeting preferences.

See how Optum can drive better risk and quality outcomes for members, health plans and providers.