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

Serving Clients Across These Segments

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.

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Compliance-First Coding

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

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Agentic AI Platform

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

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HEDIS & STARS

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

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HIPAA & SOC 2

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

Need a custom revenue integrity solution? We will scope it in 48 hrs.

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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 reducing 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 Starscomposite 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.