Enterprise Healthcare Data & Risk Intelligence
Turn Clinical Data Into Revenue and Quality Performance.
We built the tools we wished existed when we were managing multi-source data chaos, racing CMS submission deadlines, and justifying RAF scores to RADV auditors. AssureLogix combines deep CMS regulatory knowledge with enterprise data engineering — so your team focuses on patient outcomes, not pipeline plumbing.
From Bronze ingestion to Gold analytics, every layer is purpose-built for MSSP, ACO REACH, Medicare Advantage, and Medicaid MCO compliance — with real-time Kafka streaming, AI-powered HCC evidence mining, and an audit trail that withstands RADV scrutiny.
AssureLogix unifies clinical, claims, and enrollment data into a single HIPAA-compliant pipeline — automating CMS-HCC V28 risk adjustment, HEDIS quality measures, and care gap management for ACOs, health plans, and risk-bearing providers.
Platform Capabilities
Every module built specifically for CMS program compliance, risk adjustment revenue, and population health outcomes
CMS-HCC V28 Risk Adjustment
Three-tier scoring engine — claims-based (Tuva), clinical EHR, and AI suspecting — with automated V24/V28 blend schedules for PY2024–2026.
- Real-time RAF streaming (<5s)
- V24/V28 blend automation
- RADV-ready audit trail
HEDIS Quality & Star Ratings
19 HEDIS measures tracked across all 5 CMS Star domains with automated care gap identification, priority scoring, and measure-level population analytics.
- MA Star + MSSP APP Plus
- Per-measure population tracking
- CDS Hooks integration
Care Gap Intelligence
Automated identification and outreach routing for open care gaps, prioritized by Star Rating impact, revenue opportunity, and closure probability.
- Priority formula (star × urgency)
- Provider worklist + campaigns
- Streaming gap refresh
Multi-Payer Program Management
One platform for MSSP, ACO REACH, Medicare Advantage, MA-PD, and Medicaid MCO — each with program-specific attribution, quality rules, and financial logic.
- Simultaneous multi-program
- Attribution conflict resolution
- Shared savings calculation
AI-Powered HCC Evidence Mining
NLP extraction from clinical documents and lab results surfaces suspect HCCs before the coding deadline, with confidence-based auto-approval and MEAT documentation scoring.
- 82%+ confidence auto-approve
- MEAT scoring engine
- Bronze provenance for RADV
FHIR-Native Data Ingestion
Enterprise-grade connectors for FHIR R4, Claims/BCDA, HL7 v2, C-CDA, X12 EDI, and more — all with idempotent checkpointing and dead-letter queue handling.
- Bronze/Silver/Gold medallion
- DLQ + checkpoint recovery
- Real-time Kafka CDC
RADV Compliance & Submission
CMS Risk Adjustment Data Validation readiness with immutable audit trails, bronze provenance, and pre-submission compliance validation — 97.3/100 RADV readiness score.
- Pre-submission validation
- SFTP CMS delivery pipeline
- $1M+ recapture tracking
Provider Portal & Analytics
Patient 360, provider worklists, HCC review console, Star Rating dashboards, and TCOC analytics — all role-secured, multi-tenant, and updated in real time.
- JWT + DS4P security
- Grafana/Prometheus metrics
- Multi-tenant RLS
From Raw Data to Revenue in Days, Not Months
A proven six-stage pipeline that takes your organization from data chaos to CMS-submission-ready RAF scores
Connect
Ingest data from any source — FHIR R4 APIs, BCDA claims files, HL7 v2 feeds, X12 834 enrollment — using pre-built connectors with automatic deduplication and idempotent checkpointing.
Unify
Bronze → Silver canonicalization normalizes ICD-10, SNOMED, LOINC, and RxNorm codes, resolves patient identities across sources, and creates a single FHIR-aligned record per patient.
Score
Three-tier CMS-HCC V28 engine scores every eligible patient with full V24/V28 blend schedule compliance and streaming RAF updates within 5 seconds of new clinical data.
Identify
AI/NLP mines clinical documents and lab results to surface suspect HCCs and open care gaps, prioritized by Star Rating impact and estimated annual revenue opportunity.
Act
Provider worklists, outreach campaigns, and CDS Hooks surface the right intervention at the right time — automatically refreshing as new diagnoses hit the pipeline.
Submit & Comply
Pre-submission compliance validation, RADV evidence packaging, and SFTP delivery to CMS — with immutable audit trail and bronze provenance for every submitted HCC.
Built for Every CMS Program You Operate
Each program has its own attribution methodology, quality measure set, and financial rules — all configured in YAML, nothing hardcoded
Claims plurality attribution, APP Plus quality, shared savings up to 75%, 3% growth cap enforcement — Basic and Enhanced tracks.
Prospective alignment, health equity measures, global vs. professional capitation — with CMS Innovation Center model rules built in.
Enrollment-based attribution, Star Ratings, QBP benchmark increase (4+ stars = 5%), RAPS/EDS submission, coding intensity adjustment.
Combined Part C + Part D star ratings. D07/D08/D09 medication adherence, MTM completion, SUPD — Part D = 34% of overall star.
State capitation rates, CDPS risk model, HEDIS subset, CMS Adult and Child Core Sets — configured per state contract.
One platform managing multiple programs at once. Attribution conflict resolution, shared savings alongside capitation, unified reporting.
Not sure which programs apply to your organization?
Talk to a CMS Program ExpertWhy AssureLogix?
See how we compare to building in-house or relying on legacy healthcare IT vendors
| Capability | AssureLogix | Build In-House | Legacy Vendor |
|---|---|---|---|
| Time to Production RAF Scores | days | months | weeks |
| CMS-HCC V28 V24/V28 Blend Automation | |||
| Real-Time RAF Streaming (<5s) | |||
| RADV Audit Readiness Score | 97.3/100 | varies | varies |
| Multi-Program (MSSP + MA + Medicaid) | |||
| AI HCC Evidence Mining (NLP) | |||
| HIPAA + 42 CFR Part 2 (DS4P) | |||
| Config-Driven Onboarding (No Code) | |||
| FHIR R4 + Claims + HL7 + EDI | |||
| Provider Portal + Patient 360 |
Enterprise-grade CMS compliance without the 18-month build timeline
Request a Platform AssessmentWhat ACO and Health Plan Leaders Say
Trusted by risk-bearing organizations across MSSP, MA, and Medicaid
“We identified over $1.1M in HCC recapture opportunities in the first 30 days — and had the immutable audit trail to back every single one of them at RADV review. No other platform gave us that level of confidence.”
“The real-time RAF streaming changed how our care managers operate. A new diagnosis hits the EHR and within seconds it's reflected in the risk score and the gap is already in the provider worklist. That's never been possible before.”
“Finally a platform that understands both CMS regulatory complexity and modern data engineering. The RADV readiness dashboard alone saved us months of pre-audit scrambling. We went live across three programs in under 30 days.”
Built by Healthcare Data Engineers, for ACOs and Health Plans
We built the tools we wished existed when we were managing multi-source data chaos, racing CMS submission deadlines, and justifying RAF scores to RADV auditors. AssureLogix combines deep CMS regulatory knowledge with enterprise data engineering — so your team focuses on patient outcomes, not pipeline plumbing.
From Bronze ingestion to Gold analytics, every layer is purpose-built for MSSP, ACO REACH, Medicare Advantage, and Medicaid MCO compliance — with real-time Kafka streaming, AI-powered HCC evidence mining, and an audit trail that withstands RADV scrutiny.
Frequently Asked Questions
Common questions from ACO and health plan teams evaluating the platform.
Which CMS programs does AssureLogix support?
How long does onboarding take?
Is the platform HIPAA and RADV compliant?
How does the CMS-HCC V28 transition work?
What data sources can AssureLogix ingest?
What is the pricing model?
Have a specific question about your program configuration or data sources?
Talk to an EngineerGet In Touch
Talk to our team about your healthcare data challenges
Let's Solve Your Data Challenges
Whether you're managing multi-source data chaos, racing CMS submission deadlines, or preparing for a RADV audit — our team is ready to help you build a pipeline that works.