Patient Risk Adjustment & HCC Coding by Martlet AI

Martlet AI transforms HCC coding and risk adjustment operations into an in-house intelligence capability that combines automation, explainability, and control.

Developed by the experts behind John Snow Labs, Martlet applies healthcare-specific natural language processing models and large language models to analyze structured and unstructured clinical data. The engine automates both suspective and retrospective HCC workflows:

• Suspective Review: Identifies undocumented or under-coded chronic conditions from clinical text.
• Retrospective Review: Validates existing HCCs against MEAT and CMS criteria, supported by an interactive coder-facing UI for human verification and CMS submission readiness.

Unlike external SaaS tools, Martlet is deployed entirely within your AWS environment, ensuring that no PHI leaves your infrastructure. The system integrates seamlessly with EHRs, claims data, and internal coding workflows, allowing healthcare organizations to improve accuracy, reduce audit exposure, and increase reimbursement efficiency, while maintaining total governance over data and models.

Delivered as a professional services engagement, the Martlet AI team manages deployment, configuration, and tuning of the engine inside your AWS environment. The

process includes data access setup, model calibration to your patient population, and coder enablement on the Martlet UI. Once implemented, your organization operates a self-contained, agentic HCC engine, one that continuously learns from coder feedback and adapts to evolving CMS documentation standards.

Key Benefits:

• Automate HCC identification and validation across risk adjustment workflows.
• Empower coders with explainable AI evidence and transparent model reasoning.
• Eliminate vendor dependence by running securely within your AWS environment
• Strengthen compliance and audit readiness with CMS-aligned documentation validation.
• Improve coding accuracy and financial performance through in-house AI capability.

Ideal Customers: Medicare Advantage Organizations, Accountable Care Organizations (ACOs), Medicaid Managed Care Plans, Exchange Health Plans, and large Provider Groups.