OMB Individually Reported
RADV Medical Record Review
Low riskExact public inventory row
Description
(Marketplace) RADV entails the review of enrollees' medical records to determine if diagnoses submitted to CCIIO for purposes of calculating RA transfers actually exist. This medical record review is time- and resource-intensive for KPMG (and therefore CCIIO).
Detailed example
Reduce time (and therefore costs) spent on RADV medical record review
AI / analytics pattern
Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relationships.
Automation level / stage
a) Pre-deployment – The use case is in a development or acquisition status.
Expected benefit
Improve efficiency of medical record review by flagging diagnoses for KPMG coders to review.
Controls / human review
ATO: Not reported; PIA: Not published