Health Data Max LLC

AI-Powered Risk Analytics

health AImedtechhealthcare risk adjustment

Employees4

LocationArlington, VA

Business modelB2B SaaS, enterprise software for healthcare risk adjustment workflows

About

Health Data Max is transforming the future of risk adjustment through AI-enabled, end-to-end automation for Medicare Advantage and ACA payers, ACOs, and risk-bearing providers. Our Risk Adjustment SaaS Platform unifies the entire lifecycle — from prospective suspecting and retrospective chart review to encounter validation, submission tracking, and RADV audit readiness — powered by Agentic AI and healthcare-trained large language models (LLMs). We help organizations move beyond manual workflows and fragmented systems by providing real-time visibility into every encounter and submission. Our platform analyzes historical claims, lab, and pharmacy data to identify missed or under-documented HCCs, automates chart review using NLP copilots, and validates documentation against CMS submission logic — ensuring compliance, accuracy, and complete revenue capture. Key Capabilities: Prospective Suspecting: Predict and prioritize under-coded members using historical and predictive data. Retrospective Review: AI copilots extract diagnoses, evidence, and coding gaps from unstructured medical charts. Agentic AI Validation: Automate claim-to-chart verification and detect missing, unsupported, or duplicate submissions. RADV-Focused LLM Models: Purpose-built models simulate CMS audit logic to flag risk exposure and suggest corrective actions. Lifecycle Tracking: From patient visit to CMS submission and audit resolution — full traceability in one secure platform. With Health Data Max, organizations can proactively identify risk, ensure data integrity, and recover missed revenue — all while maintaining compliance and audit readiness. Revolutionizing Risk Adjustment — from Prediction to Proof. 🌐 www.healthdatamax.com

Product

Value proposition: An AI-driven risk adjustment platform that normalizes fragmented data from charts, claims, and CMS files to deliver accurate, compliant, audit-ready risk adjustment insights end to end.
Target customers: US healthcare providers, Medicare Advantage (MA) plans, health systems, risk adjustment teams, auditing entities
Regulatory: Not explicitly stated (compliant-focused, mentions CMS, RADV readiness)

Founders

Not explicitly named (company states founders have combined experience in healthcare technology and machine learning)

Products

Risk Adjustment PlatformAudit-Ready AIEncounter Submissions EngineEHR and coding integration

Key features

Scans structured and unstructured clinical data using NLP and fine-tuned LLMsIdentifies HCCs and missed coding opportunitiesProvides compliant code suggestions with source-linked evidenceSupports prospective, concurrent, and retrospective reviewsMaintains a full audit trailIntegrates with EHRs and coding platforms

Technologies

NLPLLMsAI-driven analyticsdata normalizationCMS model compatibility

Integrations

EHRs and coding platformsX12 837 I/P/DTA1, 999, 277CA, MAO-002, MAO-004, MMR, MORACA EDGE Server XML files

Target conditions

risk adjustment outcomesHCC coding qualityCMS RADV readiness

Care settings

hospitalclinicvirtual

Certifications

HIPAA

Traction metrics

~550 MA contracts audited per year — up from about 60Audit volume change +900%Records per contract 35–200MRs per audited HCC up to 2Payment years in scope 2018–2024PY2020–PY2025 audits scheduled · Findings extrapolated across the contract

News

Risk Adjustment AI: Execution Trumps Intelligence in Medicare ... · 2026-02-13T00:00:00.000Z
Health Data Movers Earns Spot on 2025 Inc. 5000 List for Sixth Consecutive Year | Health Data Movers · 2025-08-13T18:26:45.000Z
Max AI - Healthcare AI Companies - Curatrix · 2026-01-26T00:00:00.000Z
How GoML built a generative AI copilot to boost longitudinal patient data analysis for Max Healthcare · 2026-04-01T16:56:20.000Z
Home - Maxwell Health · 2025-12-16T05:14:35.000Z
How MAVA Delivers Rapid Payer and Provider Insights Without Adding Work to Your Team | eMAX Health · 2025-08-08T00:00:00.000Z

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Profile updated Jul 29, 2026. Sources: healthdatamax.com, linkedin.com