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Quality Programs Depend on Accurate Records

Stop finding out a retrieval failed weeks after the fact. Verisma gives you accurate records and real-time visibility so you can act before the window closes.
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Client Sites Across All 50 States
19500 +
Health Plan Enrollees Supported
1 M+
Of the Top 10 U.S. Health Plans Deployed
1

What's at Risk

In value-based care, every retrieval failure has a financial consequence:

  • Diagnoses go uncoded
  • Care gaps remain open
  • RAF scores are underestimated
  • RADV records fail audit

Where the Model Breaks Down

Traditional retrieval models can’t keep up:

  • No real-time insights into progress or gaps
  • Fragmented tools and manual follow-up
  • Inconsistent record quality and rework
  • Poor provider experience lowers response rates
Medical record retrieval for health plans

Meet the Retrieval Platform Built for Health Plans.

Finding the right records requires knowing provider systems and workflows. With decades of experience, Verisma delivers accurate, compliant retrieval through Verisma Retrieval IQ™ – an AI-powered platform for value-based care. Deployed with two of the top 10 U.S. health plans.

Learn More About Verisma Retrieval IQ™

Every Quality Program You Run. Every VBC Model You Operate In.

Verisma Retrieval IQ™ brings together three integrated AI capabilities that no single-tier platform can replicate:

Better Yield Over Time

Our proprietary database learns from every retrieval, continuously sharpening outreach based on provider preferences and historical patterns.

Unmatched Record Accuracy

Every record is patient-matched, validated by experienced professionals, and checked for the quality issues that make charts unusable downstream before anything reaches your team.

Wide-Reaching Connectivity

Verisma’s Universal Connector™ reaches provider systems beyond FHIR-certified EHRs, across portals, fax, email, remote access, mail, and onsite.

Quality Programs We Support

RADV & CMS Audits

Sequenced outreach and automatic QA escalation keep audit-ready charts on schedule without your team carrying the chase.

Accurate, timely retrieval across retrospective, prospective, and concurrent programs with real-time visibility into yield and cycle time throughout.
Records retrieved and validated before the measurement window closes, in the format your abstraction process requires.
Targeted retrieval campaigns built around your care gap cohorts. Accurate documentation that supports risk sensitivity and protects incentive payments.
Retrieval support for claims validation and eligibility using the same tech-enabled model that powers your quality programs.
Verisma Heat Map
“Verisma cares about patients, members, and whole-person health.They’ve helped us grow, and we’re honored to collaborate with a partner dedicated to the proposition that healthcare should be accessible and equitable to everyone.”
Senior Manager of QI, Risk Adjustment, and HEDISVerda Healthcare
Senior Manager of QI, Risk Adjustment, and HEDIS

FAQs

Questions We Hear From Health Plans

Most retrieval vendors either do retrieval and coding together, or position themselves on technology alone. Verisma is different on both counts. We’re retrieval-only and vendor-neutral, which means we never create conflicts with your coding or abstraction partners. And we’re not just a platform — we combine AI-powered technology with experienced retrieval teams who know provider workflows inside and out. That combination is why our retrieval rate runs around 85%, compared to the industry average closer to 75%. Retrieval IQ is already deployed with two of the top 10 U.S. health plans.
In value-based care, record accuracy has a direct line to program performance. Inaccurate or unusable records mean diagnoses go uncoded, care gaps stay open, and HEDIS measures fall short — often with no visibility until you see it in your Stars rating or a clawback notice. Retrieval IQ catches those failures before they reach your coders: every record is patient-matched, quality-checked, and validated by experienced professionals before delivery.
When retrievals fail, most vendors move on. We don’t. Verisma’s exception handling process identifies why a retrieval failed and works to overturn it using our deep knowledge of provider workflows and systems. For health plans switching from another vendor, we’ll take your existing chart rejections and work to recover them — including on a pilot basis so you can see results before committing to a full program.
Retrospective retrieval looks backward after the period closes. Prospective retrieval captures diagnoses before the payment year ends — which means better RAF accuracy, fewer unsupported diagnoses at audit, and a stronger financial position heading into the following year. Verisma supports retrospective, prospective, and concurrent programs, and our analytics help you prioritize which members and providers to target before the window closes.
RADV retrieval is time-compressed and there’s no room for lag. Our sequenced, tech-enabled outreach keeps projects on schedule, and when records don’t pass QA or providers are unresponsive, we escalate automatically. Your team has real-time visibility into every record in the pipeline so nothing surprises you at submission time.
Every record is automatically classified, patient-matched, and routed through AI-powered intake regardless of how the provider sends it. Each record then goes through human review before delivery, specifically checking for the issues that make records fail downstream: wrong patient match, missing pages, illegible content, format problems. If it doesn’t pass, we go back out to the provider. Nothing reaches your team or your vendors that hasn’t cleared that full process.

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Smarter retrieval means higher RAF scores, stronger Stars ratings, and audits you can pass.

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