OptimIQ
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The operating system for risk‑bearing healthcare

Coding, risk adjustment, and revenue integrity on one evidence trail. Every code traced to the sentence in the chart.

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12
EHRs integrated
7
modules, one platform
100%
of codes cited
0
migrations
Annual wellness visit

M. Alvarez · Annual wellness visit

Medicare Advantage HMO · Dr. Reyes · 14 Jun 2026

G043999214-25E11.22N18.32Z79.4

Activity

  • OptimIQ imported the encounter from Epic · 3 min ago

One platform from the visit to the payment. Built for organizations that carry clinical and financial risk, OptimIQ connects what happens in the exam room to what gets coded, billed, and reported.

Built by physicians

Designed by practicing internists and revenue cycle veterans who know what a defensible chart looks like.

Evidence behind every code

Each finding carries the sentence that supports it, so coders, auditors, and regulators see the same proof.

Measured in dollars

Every accepted code, closed gap, and prevented denial is booked against the contract it affects.

Four engines,
one platform

Coding, risk adjustment, revenue integrity, and analytics work from the same patient data. A code accepted in clinic is the same code on the claim and in the risk score.

Explore the platform
CodeIQ · Progress note · Dr. Reyes14 Jun

71-year-old with type 2 diabetes and diabetic nephropathy.

Labs reviewed: eGFR 41 on 12 Mar and 08 Jun, CKD stage 3b.

Continues insulin glargine 24 units nightly.

Annual wellness visit completed with separately documented problem-oriented E/M.

  • E11.22T2DM with diabetic CKD98%
  • N18.32CKD stage 3b97%
  • Z79.4Long-term insulin use99%
  • 99214-25E/M with modifier 2584%

0 of 4 codedReading▍

Sent to billing

CLM-48213 · 4 codes cited · 0 edits

Codes the encounter and sends it to billing

CodeIQ reads the full note, assigns ICD-10-CM and CPT, and cites the sentence behind each code. Anything below threshold goes to a coder with the reason.

RiskIQ · M. Alvarez · visit tomorrow 08:15RAF 1.208

  • CKD stage 3b

    HCC 327 · N18.32 · eGFR 41 ×2, nephrology note

  • Diabetes with chronic complications

    HCC 37 · E11.22 · Diabetic nephropathy documented

  • Heart failure

    HCC 226 · I50.32 · Grade II diastolic dysfunction on echo

  • Major depression, moderate

    HCC 155 · F33.1 · PHQ-9 14, on sertraline

Visit prep ready

2 suspected HCCs to confirm

Surfaces HCCs before the visit, not after the audit

RiskIQ flags suspected conditions as charts arrive, each cited to labs, notes, and medications. Accept, hold, or reject in one click.

RevenueIQ · CLM-48213 · 837P$1,284.00

Running rules engine

  • NCCI procedure-to-procedureChecking…
  • MUE units per date of serviceQueued
  • Modifier 25 documentationQueued
  • Payer frequency limitQueued
  • Timely filing windowQueued

Checks every claim before it leaves

RevenueIQ runs NCCI, MUE, and payer policy edits before submission. It fixes what it can and routes the rest.

Analytics · Net financial impactAll contracts

$4.82M

+18.4% vs prior period

Shows leadership what it’s worth

Recovered revenue, RAF accuracy, and denial trends by contract, facility, and module.

VisitIQ · Morning huddle24 / 24 prepared
  • 08:15M. Alvarez2 diagnosis gaps
  • 08:40D. WeeksCoverage cleared
  • 09:10P. RaghunathanCCM eligible
  • 09:45T. BoyleTCM window open

Prepares the day before it starts

VisitIQ, EligixIQ, and CareIQ summarize every chart, clear coverage, and flag program eligibility before the first patient.

From chart to ledger, OptimIQ does the validation work.

01

Connect and read

Reads charts, claims, ADT feeds, and eligibility over FHIR R4, HL7 v2, and X12. Your data stays where it lives.

Explore integrations
Sources7 connected
  • EpicSynced just now
  • Oracle HealthSynced 12s ago
  • athenahealthSynced 40s ago
  • ClaimsSynced 1m ago
  • ADT feedsStreaming
  • EligibilitySynced 3m ago
  • LabsSynced 5m ago

ADT^A04 received

Epic · M. Alvarez · admit registered

02

Validate and cite

Pairs every code with the sentence that supports it, then checks it against NCCI, MUE, and payer policy.

Explore CodeIQ
Nephrology note · M. Alvarez14 Jun

Follow-up for chronic kidney disease. Reports good adherence to lisinopril and insulin glargine.

eGFR 41 on 12 Mar and 08 Jun, consistent with CKD stage 3b secondary to type 2 diabetes.

Continue current regimen. Repeat renal panel in three months.

Cited code

N18.32 · CKD stage 3b

Evidence2 labs, 1 note

HCC327

Confidence97%

NCCI / MUEPass

03

Route and fix

Sends clean claims to billing and routes open gaps to the right clinician, with the evidence attached.

Explore RevenueIQ
Routing · today1,284 processed
  • CLM-48213Sent to billing0 open edits
  • CLM-48222Fixed and sentI11.0 combination code
  • Dr. ReyesGap to confirmPHQ-9 follow-up, F33.1
  • CLM-48241To coderConfidence 84%, below threshold
  • CLM-48236Sent to billing0 open edits

Gap sent to Dr. Reyes

PHQ-9 follow-up · evidence attached

04

Measure and report

Books the result. Leadership sees the dollar and RAF impact of every finding, traced back to the chart.

Explore analytics
Impact ledger · Meridian HealthQ3 2026

Net financial impact

$4.82M

FindingSourceRevenueRAF
N18.32 acceptedCLM-48213+$1,284+0.127
I11.0 correctedCLM-48222+$486+0.360
Denial preventedCLM-48230+$2,210—
Modifier 25 addedCLM-48213+$118—
Coverage clearedCLM-48217+$312—

Connect once, close gaps wherever your teams work

  • Epic

    Reads notes, labs, and orders

  • Oracle Health

    Reads encounters over FHIR R4

  • athenahealth

    Syncs claims and remittance

  • eClinicalWorks

    Reads problem lists and notes

  • X12 837

    Checks claims before they’re sent

  • X12 835

    Finds underpaid remittance

  • X12 270/271

    Verifies coverage before the visit

  • HL7 v2 ADT

    Flags admits and discharges

Enterprise security
with a complete audit trail

  • HIPAACompliant
  • SOC 2Type II
  • HL7 FHIRR4
  • BAA signed on every engagement
  • Every finding and decision is logged
  • Role-based access with SSO
  • Encrypted in transit and at rest
  • Human review below confidence thresholds
  • Runs inside your existing EHR workflows

Built for the organizations
that carry the risk

Health plans, risk-bearing health systems, and the groups that manage the contracts between them.

Health plans & payers

Score risk accurately before submission. Prospective and retrospective HCC review on one queue, with RADV-ready evidence on every code.

Risk-bearing health systems

Get paid for the care you deliver. Autonomous coding direct to billing, and gap summaries inside Epic and Oracle Health before each visit.

ACOs, MSOs & full-risk groups

See every contract in one view. RAF, quality, and cost trends by practice, payer, and contract, ready for the board.

Every gap in care, visible before the visit.Every dollar, traced to the chart.

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