Solving the complexity of medical coding
Inaccurate coding can lead to revenue loss and compliance risk, especially with changing guidelines and increased auditing. Carelon Global Solutions offers strategic coding support powered by clinical expertise, certified professionals and intelligent automation to strengthen accuracy, compliance and outcomes.
Accelerated risk optimization for sustainable revenue
We empower health plans and providers to drive revenue integrity while minimizing operational overhead through risk-aligned automation and coding precision.
- Compliant HCC coding across all lines of business ensures accurate RAF score capture and optimized reimbursement
- We reduce administrative strain while advancing risk accuracy, creating space for clinical focus and financial strategy
Intelligent coding & compliance engine
Our offering blends automation, analytics, and regulatory expertise to streamline coding workflows and enhance audit-readiness.
- Automated coding for accuracy auto-populates ICD-10 and HCC codes, verifies sufficient clinical evidence, and extracts hidden indicators to ensure high-fidelity capture
- Advanced text recognition boosts precision by intelligently interpreting handwritten notes and medical abbreviations, reducing manual review time
- Strategically select optimal encounters, assigns audit scores, and auto-generates compliance reports to minimize repayment risks
Empowering providers and enhancing ratings
We help close care gaps and improve quality ratings through targeted outreach and provider-informed documentation strategies.
- Improved STARS and HEDIS outcomes
- Digital suspecting engine
- Behavior-driven analytics
Driving operational excellence in risk and quality
Our people and insights work together to keep risk and quality operations moving forward.
- Flexible delivery model with coders trained across multiple programs and tools
- Real-time dashboards and configurable quality assurance workflows
- Gap analytics and coding overreads for process optimization
Precision coding and predictive insights to optimize risk capture
Fueled by deep coding expertise and enterprise-grade scalability, Carelon Global Solutions empowers smarter risk adjustment and quality transformation.
1M
medical records completed
$1.8M
in leakage prevented via risk adjustment improvements
40%+
productivity improvement in three years
100%
On time CMS Submissions
99%+
medical coding accuracy
