A reference, not a pitch
Every serious risk adjustment software vendor, on one page.
Ten platforms that suspect, capture, code, or audit HCCs for Medicare Advantage plans, IPAs, MSOs, and ACOs, compared on the things that decide a 2026 purchase: capture model, AI approach, RADV defensibility, submission-lifecycle visibility, and externally validated results. Claims are dated and linked. Picks are by job, not by a made-up score. The publisher is disclosed below.
Picks by job
Start from the job, not the brand.
KLAS split its 2026 risk adjustment awards across different vendors for different jobs, and that matches what buyers find in practice: nobody owns the whole category. These are the strongest fits we can defend for each job as of August 2026.
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Unified, real-time risk operations
Prospective and retrospective capture reconciled on one member record shared with quality, pharmacy, and care management, V28 trumping applied live, and each diagnosis tracked from 277CA acknowledgement through the MOR. The tradeoffs are real: it is a newer company with a smaller install base than anything else on this page.
Disclosure: Pelica Health publishes this directory. Weigh this pick accordingly; the competing picks below are stated just as plainly.
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Coding & retrieval throughput
The strongest externally validated option in the directory: 2026 Best in KLAS in Risk Adjustment (Coding, Retrieval and Compliance Solutions) at 90.5 and in Outsourced Coding at 94.9, with 4.5 million charts coded annually at a cited 98% accuracy. If your constraint is retrieval and coding volume, start here.
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Scaled retrospective review & RADV response
Built for high-volume chart review, with an all-in-one RADV Audit product shipped October 2025 and managed CMS and RADV-IVA submissions. Since EVE Hybrid AI launched in January 2026 it competes on prospective suspecting too.
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Point-of-care & in-home capture
2026 Best in KLAS in Risk Adjustment: Point of Care and In-Home Health Assessments at 91.2. Its PayerOne Risk product sits exactly where V28 pushed the capture decision: the encounter itself.
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Enterprise payer data platform
Risk adjustment as one workflow on a unified payer data model, with 2026 Best in KLAS in Data Analytics Platform for Payers at 90.5 and a shift toward outcome-based, per-task pricing announced April 2026. The right shape for an enterprise plan standardizing its data layer first.
Side by side
The full comparison.
Positioning is summarized from each vendor's public materials and dated announcements. Capabilities vary by contract and scope; confirm current details with the vendor before you buy.
| Vendor | Capture model | AI approach | RADV & audit | Submission lifecycle | 2026 KLAS | Best fit |
|---|---|---|---|---|---|---|
| Apixio (Datavant) | Retrospective, prospective, and concurrent | NLP and machine-learning coding predictions with certified coder review | AI-powered HCC auditing and compliance tools | Coding-cycle focused | Within Datavant's awards | MA and ACA organizations scaling coding accuracy |
| Arcadia | Retrospective-led analytics | Data lakehouse with risk analytics | Analytics view, not a coding engine | Analytics view | Not awarded in category | Health systems and ACOs building a data foundation |
| Cozeva (Vatica) | Prospective, point-of-care and in-home | PayerOne Risk with native-FHIR certified measure engines | Point-of-care documentation support | Not its primary focus | 91.2 POC & in-home | Plans and groups prioritizing capture at the encounter |
| Datavant | Retrospective coding and retrieval at scale, plus outsourced coding | Clinical Insights Platform: NLP coding with certified coder review | Compliance solutions; audit-grade coding review | Coding and retrieval focused | 90.5 coding/retrieval · 94.9 outsourced | Plans outsourcing retrieval and coding volume |
| ForeSee Medical | Prospective, point-of-care | NLP disease-detection engine inside the EHR | InstaVu links each suspect to its source page | Not its primary focus | Not awarded in category | Practices wanting EHR-embedded suspecting |
| Innovaccer | Both, via the Galaxy payer platform and Gravity agents | Unified data model with an AI agent layer | Part of broader risk and quality workflows | Within the platform | 90.5 payer analytics | Enterprise plans standardizing on one data platform |
| Navina | Prospective, point-of-care | Clinician copilot; EHR-native condition detection | Evidence linked to the chart | Not its primary focus | Won Clinician Digital Workflow in 2025, not 2026 | Physician groups working in the exam room |
| Pelica | Both, real-time, on one shared record | Risk Adjustment Copilot plus an action layer that executes follow-through | Chain-of-custody per HCC; trumping applied live | 277CA through MOR, per diagnosis, one view | Not yet rated (founded 2025) | Risk-bearing IPAs, ACOs, and plans replacing vendor sprawl |
| RAAPID | Retrospective and concurrent | Neuro-symbolic AI with knowledge-graph clinical NLP | MEAT-based audit trail; dedicated RADV solution | Coding and audit focused | Not awarded in category | Teams prioritizing defensible, traceable coding at scale |
| Reveleer | Both; retrospective abstraction plus prospective suspecting since January 2026 | EVE Hybrid AI: generative extraction paired with clinician-authored deterministic rules | All-in-one RADV Audit SaaS; manages CMS and RADV-IVA submissions | Submission and audit focused | Not awarded in category | Plans running scaled chart review and audit response |
The directory
All ten vendors, alphabetically.
Listed in alphabetical order on purpose. Each entry links to a fuller profile with a fact sheet and dated sources.
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Apixio
Coding engine · part of DatavantApixio has been Datavant's value-based care coding engine since September 2024, so evaluate it as part of that platform rather than as a standalone buy. The technology spans retrospective, prospective, and concurrent coding, pairing NLP and machine-learning predictions with certified coder review, and includes an AI-driven HCC auditing product.
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Arcadia
Data platformArcadia is a data foundation, not a coding engine: a lakehouse and longitudinal record with risk analytics layered on top. Nordic Capital took a majority stake in July 2025. The right first purchase when an organization's constraint is clean data rather than capture workflow.
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Cozeva
Point-of-care · merged with Vatica HealthCozeva merged with Vatica Health on October 31, 2025, and took the 2026 Best in KLAS award for Risk Adjustment: Point of Care and In-Home Health Assessments at 91.2. Its PayerOne Risk product works the encounter itself, which is where V28's tighter mappings moved the capture decision.
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Datavant
Coding, retrieval & complianceDatavant deserves more shortlist slots than it gets. Two 2026 Best in KLAS wins, Risk Adjustment (Coding, Retrieval and Compliance Solutions) at 90.5 and Outsourced Coding at 94.9, plus a cited 4.5 million charts coded a year at 98% accuracy, make it the most externally validated vendor in this directory for throughput jobs.
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ForeSee Medical
Point-of-care suspectingForeSee embeds an NLP disease-detection engine directly in the EHR and shows HCC suspects during the visit, with its InstaVu feature hyperlinking each suspect back to the exact page of source documentation. A focused fit for practices that want suspecting inside the workflow they already have.
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Innovaccer
Enterprise platformInnovaccer treats risk adjustment as one workflow on its Galaxy payer platform, with Gravity AI agents on top and a 2026 Best in KLAS win in Data Analytics Platform for Payers at 90.5. In April 2026 it announced a move from software-access fees to outcome-based, per-task pricing and a $250M three-year commitment to the agent platform.
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Navina
Clinician copilotNavina is the clinician-first option: it condenses EHR, HIE, and claims data into a visit-ready summary, raises suspected conditions at the point of care, and supports one-click documentation in the chart. It raised a $55M Series C in March 2025 led by Growth Equity at Goldman Sachs Alternatives. Its Best in KLAS win in Clinician Digital Workflow was 2025; TransformativeMed took that category in 2026.
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Pelica Risk Adjustment Copilot
Unified operations · the publisher's productPelica runs prospective and retrospective capture in real time on one member record shared with quality, pharmacy, network, and care management teams, applies V28 constrained-group trumping as conditions are captured, attaches chain-of-custody evidence to every HCC, and tracks each diagnosis from 277CA through MAO-004, MMR, and MOR in a single view. The honest tradeoffs: founded in 2025, no KLAS rating yet, and a smaller install base than any other vendor here. Pelica Health publishes this directory.
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RAAPID
Audit-transparent codingRAAPID's design leans hardest into audit transparency: neuro-symbolic AI and knowledge-graph clinical NLP that produce a MEAT-based evidence trail for every HCC, with autonomous retrospective review and a dedicated RADV product. For teams whose first requirement is defensibility, that architecture is the draw.
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Reveleer
Retrieval, review & RADVReveleer built its business on high-volume retrospective chart review and now covers far more: the Curation Health acquisition (October 2024) added point-of-care rules with Epic, Cerner, and Athenahealth integrations, an all-in-one RADV Audit SaaS shipped October 2025, EVE Hybrid AI added prospective suspecting in January 2026, and an April 2026 Clinical Data Repository unifies member records across risk, quality, RADV, and care management. It sells primarily to plans; delegated provider groups usually sit on the other side of that contract.
How to evaluate
Five things that separate the 2026 buy from the 2024 buy.
V28 finished phasing in for payment year 2026 and cut roughly a fifth of the ICD-10 codes that used to map to an HCC. That single change reorders what matters in this category.
Both directions, one record
Prospective capture documents the diagnosis inside the year it is clinically valid; retrospective review recovers what was missed and feeds audit response. Run as two disconnected tools, the two views never reconcile. Ask to see one member whose prospective suspects and retrospective findings appear on the same record.
Live V28 trumping logic
V28's constrained groups pay a single coefficient for related conditions, so documenting more of them raises audit exposure without raising RAF. Software should compute trumping as conditions are captured, so coders never chase diagnoses that cannot pay.
Chain-of-custody by default
The source note with MEAT support, labs or imaging, attestation, and coder review record should attach to every HCC automatically. If the evidence packet gets assembled by hand after a RADV notice, the program is not defensible; it is lucky.
Lifecycle visibility, 277CA to MOR
A diagnosis is not captured until CMS recognizes it. Demand per-diagnosis tracking across the 277CA acknowledgement, the MAO-004 eligibility report, the MMR payment report, and the MOR model output. MAO-004 rejections are the earliest warning that documentation will not survive an audit.
Specific, pre-claim prompts
Generic nudges ("review chronic conditions") do not move capture. Prompts that name the condition and the clinical criteria ("CKD stage 3a documented in 2024; confirm staging today") do. Watch a live encounter in the demo and judge the prompts yourself.
FAQ
Common questions.
What does risk adjustment software actually do?
It helps Medicare Advantage plans, IPAs, ACOs, and medical groups document the chronic conditions their members actually have, so CMS payment reflects the real clinical risk of the population. In practice that means suspecting likely HCC diagnoses from claims and clinical data, surfacing them to clinicians or coders for confirmation, attaching audit evidence, and tracking each submitted diagnosis until CMS accepts it. Vendors specialize: some work at the point of care, some in retrospective chart review, some in analytics, and a few try to cover the whole cycle.
Do I need prospective or retrospective risk adjustment software?
Most risk-bearing organizations need both. Prospective tools work at or before the visit so a valid diagnosis gets documented inside the service year, which matters more under V28's tighter code-to-HCC mappings. Retrospective tools review charts after the fact to recover missed diagnoses and support audits. The practical question is whether the two run on one shared member record or as two disconnected tools whose views never reconcile.
How did CMS-HCC V28 change what to look for in a vendor?
V28 is fully phased in for payment year 2026. It shrank the ICD-10-to-HCC crosswalk from roughly 9,797 codes under V24 to about 7,770, expanded the model to 115 condition categories, and CMS actuaries projected an average MA risk-score reduction of about 3.12%. Software that only reports after claims settle now surfaces losses after the window to fix them has closed, so V28-aware suspecting before the encounter, live constrained-group trumping logic, and full submission tracking became the differentiating features.
Which risk adjustment vendors won 2026 Best in KLAS?
KLAS split the category across several awards in 2026, all announced February 4, 2026. Datavant won Risk Adjustment (Coding, Retrieval and Compliance Solutions) at 90.5 and Outsourced Coding at 94.9. Cozeva, now merged with Vatica Health, won Risk Adjustment: Point of Care and In-Home Health Assessments at 91.2. Innovaccer won Data Analytics Platform for Payers at 90.5. No single vendor swept the category, which supports choosing by the specific job you need done.
What makes an HCC capture RADV-defensible?
Every captured HCC should carry a retrievable evidence packet the day an auditor asks for it: the source clinical note with MEAT support, relevant labs or imaging, any provider attestation, and the coder review record. Constrained-group trumping has to be applied correctly so only the highest-weighted condition in a group reaches the claim. The test is whether chain-of-custody is a built-in property of the software or a packet someone assembles by hand after a RADV notice arrives.
Who publishes this directory?
Riskadjustmentsoftware.com is published by Pelica Health, Inc., the company behind the Pelica Risk Adjustment Copilot, which appears in the directory alongside nine competitors. Vendor information is drawn from public sources that are dated and linked on every profile, competitors' strengths are stated plainly, and the ownership relationship is disclosed so readers can weigh the publisher's perspective.
Ownership disclosure
This directory is published by Pelica Health, Inc., which builds one of the ten products listed. We keep the directory useful the only way a publisher-owned directory can be: vendor facts come from public, dated, linked sources; competitors' awards and strengths are reported plainly; and our own product's tradeoffs are listed next to everyone else's. Our evaluation criteria are documented on the methodology page. If you find an error, email directory@pelica.com and we will correct it.