Missing diagnosis codes in standard risk algorithms can lead to inaccurate risk score calculations, impacting payment strategies and care plans. Our suspect code algorithm is designed to fill these gaps by identifying potential undocumented conditions based on clinical evidence such as lab results, procedures, medications, and anomalies in vitals.

While suspect codes aren't definitive diagnoses, they serve as valuable indicators of potential risk factors. With confidence scores quantifying the likelihood of true positives, medical coders can prioritize and close gaps more efficiently.

This whitepaper analyzes the effectiveness of confidence scores based on rigorous testing across multiple population sets from different payer/provider customers and analyzes trends across probable suspect scenarios.