Scope

Your AI Co-Analyst for
Risk Adjustment.

Falcon Health · 2026

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The Problem

70+ CMS files.
Zero unified view.

Too many files, not enough time — processing all 70+ CMS files requires specialized expertise. Most plans analyze only what they can manage, missing critical revenue.
Siloed data, no accountability — RAPS, EDS, MARx, state systems, and vendor data exist in isolation. Without a unified view, errors go undetected until audits hit.
Expertise gap — finding professionals who understand CMS data flows and risk adjustment rules is increasingly difficult and expensive. The talent pool is thin.

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Scope

✓ Full 70+ CMS file coverage — auto-ingest and reconcile RAPS, EDS, MARx, MAO-002, MAO-004, MOFs, DTRRD, MCMD, and more without manual intervention.
✓ Real-time payment & enrollment reconciliation — discrepancies and mismatches surfaced before reconciliation windows close, not after audit findings arrive.
✓ raInference — statistical HCC documentation-gap analysis to prioritize RADV audit preparation and identify revenue recovery opportunities before submission deadlines.
✓ Transaction Monitor & EDPS — submissions tracked and urgency-scored across the full risk adjustment lifecycle, so nothing falls through the cracks.

$80–$160

PMPM Revenue Recovery

100%

CMS File Coverage (All 70+)

Minimal

Audit Risk

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Scope

Ask any question about your CMS data. Every file processed automatically, every discrepancy surfaced early, every audit trail maintained.

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