HCC Support


Waiting until September creates an annual challenge. The reality is that it is often too late then to optimize your HCC program.

There simply is not enough time to do all the work!

With PrescienceRx you can start identifying issues in April. Monthly data updates guide and support you so you have adequate time to request and obtain information from providers to resolve documentation issues.

Equally important, PrescienceRx supplies the provider information associated with the relevant drugs associated with suspect HCCs, allowing you to target information requests.

PrescienceRx utilizes monthly pharmacy claims and member demographics to identify patients where prescription drug information suggests a medical condition that may not have been documented by the CMS HCC grouper.

  • Identify patients with HCCs for a chronic medical condition reported in one time period but not recorded or recognized by the CMS grouper in subsequent time periods
  • Identify patients where evidence of current prescription medications suggest a CMS HCC not recognized by the CMS HCC grouper

Now, we recognize pharmacy data does not cover everything. Not all HCC conditions are identifiable using prescription data alone.

HOWEVER, PrescienceRx algorithms include the high volume medication-dependent chronic medical conditions that account for the greatest patient volume. In addition, we identify a number of less-frequent but high-impact medical conditions where the presence of specific drugs is an accurate marker.

Most important, we can start identifying opportunities in April instead of September.

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