Healthcare Revenue Integrity

Recover Revenue.

Reduce Risk. Elevate Accuracy. Scale Results.

Lumiknox delivers HIPAA-compliant medical coding, HEDIS, STARS, RADV, and agentic AI services for U.S. health plans, TPAs, and providers — backed by a free 50-chart pilot with 48-hour turnaround.

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98.7%

Coding Accuracy

3.2M+

Charts Annually

$420M+

Revenue Recovered

48hr

Pilot Turnaround

Chart Free Pilot

✓

HIPAA Compliant

SOC 2 Type II

Trusted Alongside Industry Leaders

⬡ Aetna · ⬡ Elevance Health · ⬡ UnitedHealth Group · ⬡ Cigna · ⬡ Humana · ⬡ BCBS Plans · ⬡ Centene · ⬡ Kaiser Permanente · ⬡ Aetna · ⬡ Elevance Health · ⬡ UnitedHealth Group · ⬡ Cigna · ⬡ Humana · ⬡ BCBS Plans · ⬡ Centene · ⬡ Kaiser Permanente

14+

Years of
Experience

About Us

Your Growth Partner, Built for Healthcare

Our mission is to help health plans, TPAs, and providers connect accurate clinical data with optimal reimbursement — amplifying revenue integrity and achieving measurable results at scale. From Hyderabad to Manila to Wilmington, our 1,200+ credentialed coders and AI engineers work as a true extension of your team.

📋

Compliance-First Coding

AHIMA-certified, RADV-ready, and audit-proof across all care settings.

🤖

Agentic AI Platform

LLM-powered pre-billing review and autonomous claims adjudication.

📊

HEDIS & STARS

End-to-end measure abstraction lifting star ratings and quality scores.

🛡

HIPAA & SOC 2

Certified infrastructure with BAA in place, zero PHI on LLM endpoints.

🔬 Need a custom revenue integrity solution? We'll scope it in 48 hrs.

Let's Work Together →

Our Services

Effective Healthcare Revenue Services

From fee-for-service coding to value-based care analytics — every service is engineered for accuracy, speed, and audit resilience.

Medical Coding & HCC Capture

Inpatient, outpatient, profee, and HCC risk coding with 98.7% accuracy and dual-coder validation across all specialties.

HEDIS Quality Abstraction

Full-spectrum HEDIS measure retrieval and abstraction supporting NCQA-compliant quality reporting for commercial and Medicare plans.

STARS & RADV Audit Support

Medicare Advantage star-lifting programs and RADV-ready documentation reviews to defend and optimize risk scores.

Agentic AI Billing & Claims

LLM-powered pre-auth, pre-billing review, and autonomous claims adjudication reducing denial rates and AR days.

AI/ML Analytics & Predictive Insights

Risk stratification, utilization forecasting, and payment integrity analytics surfacing actionable signals for payer and provider leadership.

Case Studies

Specialist Business Cases

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Health Plan

Risk Score Lift for Regional MA Plan

HCC recapture program across 280K member lives recovering previously unvalidated chronic condition codes.

$38Madditional revenue recovered in Year 1

TPA

Claims AI Deployment for National TPA

Agentic billing layer slashing prior-auth turnaround from 8 days to same-day.

67%reduction in prior-auth cycle time

HEDIS · STARS

STARS Rating Improvement Program

Comprehensive gap-closure and HEDIS abstraction raising composite star rating from 3.5 to 4.5.

4.5★composite MA rating (from 3.5) in 18 months

Testimonials

What Our Clients Say

Voices from health plans, TPAs, and provider groups across the U.S.

★★★★★

"Lumiknox's RADV audit team found documentation gaps our internal coders missed for two cycles. Their accuracy and turnaround time are genuinely best-in-class."

Sarah R.

VP Risk Adjustment, Regional MA Plan

★★★★★

"We went from a 3.5 to a 4.5-star rating in 18 months. The HEDIS abstraction work and gap-closure support from Lumiknox was the single biggest driver of that improvement."

James M.

Director Quality, Midwest Health Plan

★★★★★

"The agentic billing pilot cut our prior-auth time from 8 days to same-day. We scaled to full deployment within 60 days. Our denial rate dropped 34% in the first quarter."

Angela L.

CFO, National TPA

Insights

News & Updates

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Medical Coding · by Lumiknox Editorial · May 2025

How AI Is Reshaping HCC Capture for Medicare Advantage Plans in 2025

Agentic models are now able to surface prospective coding opportunities from unstructured clinical notes — and the revenue impact is significant. We break down the methodology.