HCFS, the industry leader in healthcare claims and audit technology, announced the launch of RecordPlus™, a breakthrough system designed to dramatically streamline the medical record review process and address the persistent issue of improper payments.

Citing industry data—where the majority of improper payments were due to missing or insufficient documentation, such as cloned records or lacking evidence to support the necessity of services provided¹—RecordPlus™ targets this core challenge by automating the most time-intensive aspects of record analysis.

Transforming Documentation into Actionable Data

RecordPlus™ is engineered to accelerate accurate audit and investigative determinations by quickly transforming complex, unstructured documents into structured, usable intelligence.

The system utilizes sophisticated Natural Language Generation (NLG), Artificial Intelligence (AI), and rule-based logic to perform rapid record analysis, enabling users to identify and extract critical health information, including:

• Protected Health Information (PHI)
• Provider details, signatures, and dates
• Anesthesia records and clinical models
• Evaluation and Management (E/M) models
• Cloning Detection
• Specific procedures and drug information

"RecordPlus™ is not just a review tool; it's an end-to-end solution that effectively closes the documentation gap," said Karen Weintraub, EVP at HCFS. "By providing instant access to validated, structured data buried deep within medical records, we are empowering reviewers to make accurate determinations faster than ever, which is crucial for protecting the integrity of healthcare data."

The Power of Total Integration

A key differentiator of the new solution is its seamless integration with the HCFSPlatform™ ecosystem, which includes AuditPlus^®, PreShield^®, PostShield^®, RxShield^®, and CaseShield^®. This total integration allows RecordPlus™ to combine its extracted insights with claims data into the review workflow. This holistic approach significantly expedites the time it takes for reviewers to make appropriate, informed determinations, ensuring consistency and compliance across all investigations.

Core Capabilities and Advantages

RecordPlus™ provides essential tools to boost efficiency and compliance:

• Key Models: Uses advanced clinical models to extract critical audit insights from complex documentation.
• Expedited Searching: Features intelligent indexing and filtering tools for rapid information retrieval.
• Data Security: Recognizes PHI and secures sensitive data throughout the review workflow.
• Validation: Links Claims to Records for streamlined review and validation.
• Compliance: Identifies Relevant Policies to support compliance and audit accuracy.
• Visibility: Offers real-time visibility into request status and documentation completeness.
• Seamless Integration: Works with AuditPlus^®, CaseShield^®, PostShield^®, and other HCFSPlatform™ components.