Proprietary Confidence Score and agentic tools improve performance and value for risk-bearing payers
HERNDON, Va.–(BUSINESS WIRE)–#AIMedTech—ECLAT Health Solutions, a leading risk adjustment and coding technology partner for Medicare Advantage, Medicaid and ACA plans, announced agentic AI tools and proprietary Confidence Scoring at RISE National 2026. These new solutions complete ECLAT’s suite of end-to-end AI-powered chart review, coding and analysis tools that improve risk adjustment and quality initiatives to provide stronger value to payers.
“Every record, every code and every claim matters as government payers and at-risk health groups are squeezed thin,” said Gabe Stein, CEO, ECLAT Health Solutions. “evaire’s AI-powered tools are some of the first purpose-built solutions using agentic AI and leading industry experience to drive stronger efficiency and value, while limiting audit and compliance risk.”
ECLAT’s Confidence Score provides diagnosis-level documentation validation, using agentic AI to proactively identify unsupported ICD-10 codes and assign a Confidence Score noting the probability a diagnosis lacks adequate documentation support. The result is a quantitative metric indicating which records contain new codes or documentation for review, and which to skip, within 99%+ accuracy. This guidance will be critical as CMS continues to demand stronger, defensible documentation for reimbursement.
ECLAT has also introduced a new chart retrieval tool, evaire Retrieve, which automates outreach and tracking to simplify provider requests and improve chase efficiency. While other solutions simply retrieve charts from a chase list, leaving payer organizations to manually review each record in search of codes, Retrieve uses evaire’s purpose-built machine learning and agentic AI to review each document for Confidence Scoring.
“Health tech and risk adjustment solutions remain largely siloed, ultimately limiting AI’s impact,” Stein said. “By considering the whole risk adjustment process, pinpointing problems and fueling innovation to solve them, evaire offers wraparound AI solutions that drive stronger outcomes to extend ROI across multiple areas of operations.”
At RISE, ECLAT CEO Gabe Stein will host a panel of diverse healthcare leaders discussing how organizations can move beyond hype and identify where AI makes the strongest impact to drive true results. The panel will take place Tuesday, March 24, at 3:55 p.m. ET.
Learn more about ECLAT’s AI solutions for payers and the future of AI in risk adjustment at the ECLAT booth #403 at the show.
About ECLAT Health Solutions
ECLAT partners with the nation’s leading hospitals, health systems, government payers and at-risk health groups to improve financial performance, coding accuracy, and AR. Fueled by its analytics and AI platform, evaire, ECLAT leverages Agentic AI and the industry’s most qualified staff to analyze clinical documentation, identify coding opportunities and deletes, ensure compliance, and deliver actionable insights to both providers and payers. By pairing expertise and automation across the healthcare continuum, ECLAT drives unmatched outcomes and delivers transparent, defensible results that healthcare organizations can trust. Learn more at ECLAThealth.com.
Contacts
Media Contact
Trent Freeman
Innsena for ECLAT Health Solutions
[email protected]
