Introducing Retro+ Review: Rethinking Retrospective Coding with AI

Here's what payers are experiencing: CMS's RADV audits are getting more thorough. Fraud, waste, and abuse investigations are intensifying across Medicare, Medicaid, and ACA programs. The regulatory environment is shifting, and the tools most organizations rely on are finding it difficult to keep pace.

This implies that both payers and payviders have a lot on the line. Serious penalties, lost income, and tarnished reputations can arise from noncompliance with CMS, HHS, and state Medicaid agencies. 

The challenge isn't just compliance, it's efficiency. Most payers are juggling multiple point solutions that don't talk to each other, creating data silos and operational friction. Meanwhile, traditional vendors have largely moved upmarket, leaving smaller and mid-sized payers with fewer options and higher costs.

Innovaccer saw an opportunity to approach this differently.

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What Makes Retro+ Review Different

Instead of adding yet another tool to payer technology stacks, Retro+ Review integrates HCC coding and quality abstraction reviews into a unified, parallel workflow. Initial medical record reviews are managed by the AI Coding Agent in accordance with organizational requirements, minimizing the need for manual effort while supporting the accuracy and compliance levels payers require.

The platform is built on three fundamental principles:

Unified Data Flow: Instead of having multiple systems for coding and review of quality, all within one environment. This does away with the handoffs of data and version control problems that clog up old-fashioned workflows.

Intelligent Automation: AI is trained from particular organizational needs and learns to adapt according to individual patterns. The system becomes intelligent by learning more data.

Scalable Architecture: Designed to grow with organizations, whether regional health plans or multi-state operations. The same platform that can serve 10,000 members can serve 500,000.

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The Impact Being Seen

The Retro+ review solution is projected to make the following impact:

• Cut 50% off admin time - No additional time spent in reviews and paperwork
• Reduce audit penalties by 80% - Anticipate CMS requirements before they become issues
• Eliminate decision waste by 60% - Produce real insights instead of estimation
• Increase the payer network efficiency by 20% 
• Detect care gaps before they harm patients - Early identification means improved outcomes
• Make better network choices - Decision-making driven by data that actually drives results

More importantly, allow teams to have visibility into their operations and more confidence in their compliance posture.

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Built for Real-World Complexity

Retro+ Review is part of our existing risk adjustment and quality management solutions and integrates with existing payer infrastructure so no rip-and-replace is required. The platform supports connections to the health record systems and data tools organizations are already using, and is aligned with upcoming CMS 0057-F interoperability standards.

Security and compliance are built-in, not bolted-on. The platform leverages Innovaccer's existing certifications and maintains the same enterprise-grade security standards across all deployment sizes.

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Partnership Approach

Innovaccer’s goal is to be a strategic partner that helps payers and payviders navigate the evolving landscape. That means understanding specific organizational challenges, adapting the platform to existing workflows, and supporting long-term success.

Interested in learning more? Please book a demo with our expert here. 

The healthcare landscape is changing faster than ever. Retro+ Review has been built to help payers not just keep up, but stay ahead.

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