Unified operations · the publisher’s product
Pelica Risk Adjustment Copilot
Prospective and retrospective capture in real time on one record shared across teams, with live V28 trumping and per-diagnosis lifecycle tracking. Published by the company that owns this directory; tradeoffs listed like everyone else’s.
- Capture model
- Both, in real time, against a single member record
- AI approach
- Risk Adjustment Copilot plus an action layer that executes follow-through
- RADV & audit
- Per-HCC chain-of-custody evidence; trumping computed live
- Submission lifecycle
- Per diagnosis, across all four CMS reports (277CA, MAO-004, MMR, MOR) in a single view
- Best fit
- Risk-bearing IPAs, ACOs, and plans consolidating point tools
- 2026 Best in KLAS
- Not yet rated; the company was founded in 2025
- Reported results
- A flagship physician-led IPA in New York runs risk on roughly 175,000 patients with 100% team adoption; customers report RAF lift of roughly +0.4 in two quarters without added headcount; deployments go live in about two weeks
Pelica starts from the observation that capture usually breaks between teams rather than inside any one of them. The Risk Adjustment Copilot raises at-risk HCCs before the encounter and reconciles retrospective review against the same member record the quality, pharmacy, network, and care management teams are already working, so a member with three open items gets one prepared visit instead of three uncoordinated calls. V28 constrained-group trumping recalculates as each condition lands, every HCC carries its evidence packet by default, and each diagnosis stays visible across the four CMS reports (277CA, MAO-004, MMR, MOR) so a rejection shows up while there is still time to answer it.
Pelica Health publishes this directory. The tradeoffs: the company was founded in 2025, holds no KLAS rating, and has a smaller install base than any other vendor listed here. Its reported figures come from its own published customer material, linked below, and have not been checked by an independent rater.
Choose it when
Risk-bearing IPAs, MSOs, ACOs, and plans that would rather add one operating layer across risk, quality, pharmacy, and care management than add an eighth point tool.
Look elsewhere when
Buyers who require a long reference list or an established KLAS track record before purchasing.
Related profiles
Sources
- Pelica Health: platform and published customer results
- Pelica Health: risk adjustment page
- pelica.com (official site)
Positioning summarized from public materials current in August 2026. What a given customer receives depends on contract and scope, so confirm the details with the vendor. Spot an error? Tell us and we will correct it. Back to the full comparison →