IRIS uses AI to scan clinical documentation and highlights potential Hierarchical Condition Category (HCC) codes before annual and semi-annual assessments. AI suggestions are reviewed by experienced risk adjustment consultants and then surfaced to providers for review before assessments.

If you are using CareHub EMR, the integration is seamless. If you are using another EMR, we will work with your team to integrate and surface the right insights through our platform.

Our risk adjustment consultants review provider documentation and program analytics, identifying opportunities for training or retraining to ensure the integration of best practices into daily workflows, enabling quality improvements over time.

Unlike traditional, sample-based audits, IRIS audits 100% of the Medicare census twice a year.  If you are also using CareHub, IRIS will present insights directly in the participant chart.

Implementing IRIS alone can be as fast as 8-10 weeks. It includes in-person training, tailoring 1:1 coaching, and ongoing support. IntusCare encourages full team participation, not just providers, because everyone plays a role in risk adjustment success.

Yes. IRIS is regularly updated to reflect CMS changes, including the latest change in the HCC model. The system will help teams adapt to ensure you are reimbursed accurately through the transition period.

IRIS is designed to review documentation and ensure accurate and defensible risk adjustment coding through onshore certified risk adjustment coders, ensuring accurate payment for the complex care being provided.

Through IRIS pre-encounter preparation (PEP), our teams start working about two months prior to every scheduled annual or semi-annual assessment so providers can access coding suggestions before the encounter. All AI-suggested codes are reviewed and confirmed by our onshore certified experts before they’re delivered to providers.

IRIS suggestions are recommendations only. Providers review each one and confirm or reject it. Rejected suggestions are tracked so providers never have to review the same one twice.

Your risk adjustment consultant acts as an extension of your internal risk adjustment team, providing feedback, answering questions, and offering education throughout your engagement. At implementation, a consultant will be assigned, and they’ll partner with you the entire time you work with IRIS.  Risk adjustment consultants tailor the engagement to your specific program needs. 

IRIS works with a variety of TPAs, including QuickCap and Innermark, providing encounter and diagnosis data TPAs need to build CMS-ready submission files.

Because risk adjustment factor (RAF) scores are typically finalized annually and reconciled against CMS payment cycles, the most significant financial impact, the difference in per-member-per-month (PMPM) reimbursement, usually becomes visible over one full risk adjustment cycle. Factors like the size of your member population, how much undercoding or overcoding existed previously, and how quickly your team acts on IRIS’s identified gaps and insights all influence how fast that revenue impact materializes.

IRIS combines pre-encounter preparation (PEP), CMS pipeline tracking, and on-demand financial analytics in one platform, where most other solutions offer only one piece. IRIS confirms suspect conditions with certified expert validation before assessments happen, tracks submission status from documentation to reconciliation, and delivers PMPM and average RAF answers in a dynamic dashboard you can access any time, without waiting on a report.