Capture every condition at the point of care, not months later.
Pelica compares the claim against the chart in one record, surfaces the suspected HCC while the provider still has the member, and keeps the documentation attached. V28-aware trumping, RADV-defensible by design, coders working in the platform. The shift from retrospective to prospective, actually executed.
25,000+
HCC opportunities surfaced
5M+
claims & charts unified
2 weeks
to go live
The condition was treated.
The capture happened too late.
Risk-bearing organizations don't lose RAF because providers miss care. They lose it because the documentation, the coding, and the submission all happen long after the window to do them right.
Everything is retrospective.
Charts get chased months after the visit, when the provider has moved on and the documentation is whatever was written that day. The chance to capture it cleanly is already gone.
Captured at the sweep, not the visitClaims and charts live apart.
The claim says one thing, the medical record says another, and reconciling them is a manual project. Suspected conditions slip and documented ones go unsupported.
Two sources, no single truthCapture you can't defend.
Volume-driven coding looks good until RADV. Without documentation attached and a clear chain of custody, every captured condition is a liability waiting to be clawed back.
Looks good, until the auditTwo kinds of work.
Only one needs a coder.
Your coders trained to read a chart and make a judgment call, not to reconcile two systems or chase a record nobody filed. Pelica draws the line in the right place.
The work only a coder can do
- The clinical judgment on whether the chart supports the code
- The complex or ambiguous case that needs a human read
- The provider conversation about documentation
Everything that shouldn't need one
- Compares every claim against the chart and surfaces the gaps
- Applies V28-aware trumping so nothing double-counts
- Keeps RADV-defensible documentation attached to each capture
- Tracks every claim through the lifecycle, from 277CA to MOR
One canonical record.
Every claim. Real-time.
Three layers, each addressable on its own. Deployed together, the equivalent of 8 to 15 point vendors in a single platform.
Live data
Claims (277CA, MAO-004, MMR, MOR), EHR (FHIR/HL7), charts, labs, and payer SFTP drops, unified into one record per member with full ICD-to-HCC mapping for V24, V28, and HHS-HCC. Tenant-isolated, BAA-covered, encrypted end to end.
The AI workforce
The Risk Adjustment copilot sweeps claims against charts, surfaces suspected and unconfirmed HCCs, applies trumping logic, and routes each opportunity to the right coder or directly to the provider, with the supporting evidence already attached.
Action
Coders engage opportunities in the platform, providers see the most important captures at the point of care via EMR overlay, and every claim is tracked through submission so nothing slips or double-counts.
Accurate, audit-ready capture,
without adding coders.
A risk team can't out-hire the chart volume. Pelica gives the team you have leverage over every claim and every chart at once.
Move capture upstream, to the point of care.
Stop running on the retrospective sweep. Pelica surfaces the opportunity while the provider still has the member, with the documentation that makes it defensible, so RAF reflects the care that was actually delivered.
- 25,000+HCC opportunities surfaced, each with the documentation attached
- V28-awaretrumping applied automatically, no double-counting
- 277CA → MORevery claim tracked through the full submission lifecycle
Read charts. Skip the reconciliation.
Pelica does the claim-to-chart comparison and brings you the opportunities with the evidence attached, so your coders spend their time on the judgment calls instead of stitching two systems together.
- RADV-readydocumentation attached to every captured condition
- 9,000+annual wellness visit opportunities surfaced, documentation in hand
- ~10 hrsa week back, per coder, with the reconciliation automated
Live with the largest
IPA in the country.
Delivered at HealthCare Partners, a physician-led IPA managing 200,000 lives across 1,000 providers, and live within two weeks of signing.
25,000+
HCC opportunities identified, each with the supporting documentation attached.
9,000+
Annual wellness visit opportunities surfaced, ready for the visit.
V28 + RADV
Trumping and audit-defensible documentation built into every capture.
100%
Adoption across the risk and coding teams at the largest IPA in the country.
The risk leaders watching
the model change.
The operators at our flagship IPA, on why risk capture is moving upstream.
What we're seeing right now is a big shift from retrospective supplemental risk adjustment activity to prospective. Pelica interfaces directly with providers and gives them information that's impactful to their business.
Make sure things are correctly captured concurrently, and not waiting until many months later to collect a medical record. Get the information as soon as possible and make corrections at the point of care.
We can flag early compliance risks, and pick up additional documented and truly treated diagnoses that were missed by the provider.
Built for healthcare's highest compliance bar.
Tenant isolation, encryption end-to-end, full audit trail, and contractual zero-retention with every LLM provider in use. Available on request: SOC 2 Type II report, BAA template, subprocessor list, pen-test history.
Visit our Trust Center →
Risk adjustment leaders ask us this.
“Providers don't want extra clicks. They became doctors to take care of patients. Put the data that's most important to the provider directly in their hands.”
Bill Quinn
Director of Risk Adjustment · HealthCare Partners
See Pelica on data that looks like yours.
30-minute walkthrough. We'll run the Risk Adjustment copilot live on a redacted book of business from a real risk-bearing org.
Book a Demo →