iRAS Intelligent Risk Adjustment Service
Identify undocumented risk, improve coding accuracy, and strengthen RAF capture that aligns with longitudinal care delivery.
Empowering Unprecedented Visibility & Benchmarking
Bloom Value delivers modular intelligence solutions built on a shared, governed data foundation. Each offering can be implemented independently to solve a specific financial or operational challenge — yet all operate through a common intelligence layer that connects data, analytics, generative AI capabilities, agentic workflows, and expert oversight.
As organizations expand adoption, insights become interconnected, performance gaps are addressed earlier, and improvements compound across reimbursement, risk performance, cost control, and operational execution.
We serve two healthcare ecosystems:
Medicare Advantage organizations operate in CMS-regulated, capitated environments where risk score accuracy, medical cost management, and claims integrity directly determine margin, Star performance, and bid sustainability. Bloom brings clinical, claims, and operational data together to continuously surface RAF opportunities, monitor MLR performance, and prevent leakage before it compounds.
These are not isolated fixes. Improvements in coding accuracy, cost control, and claims oversight reinforce one another — strengthening contract performance, stabilizing margins, and elevating quality outcomes across the organization.
Powered by advanced analytics, generative AI capabilities, and supervised agents working alongside domain experts, Bloom helps organizations in the Medicare Advantage ecosystem turn visibility into sustained financial and operational performance.
Optimize prior authorization workflows and reduce avoidable denials.
Validate eligibility and revenue accuracy before leakage occurs.
Gain full visibility into cost performance, utilization patterns, and population trends.
Max
Delivers on-demand insights, answering follow-up questions, and initiating actions — eliminating dashboard and static report navigation.
Clara
Evaluates Star Ratings performance to pinpoint underperforming entities and measures, identify root causes, and prioritize corrective actions.
Taylor
GInitiates targeted member outreach to close identified care gaps, coordinating appointment scheduling and follow-ups to improve compliance and Star Ratings performance.
Nora
Activates structured provider outreach to close documentation gaps, validate risk conditions, and improve coding accuracy — protecting RAF performance and revenue integrity.
Hospitals and health systems face persistent margin compression as financial performance issues surface in the revenue cycle but often originate upstream in patient access, care coordination, coding, and managed care contracting. Bloom connects these operational and financial signals - from patient status and authorization through reimbursement and accounts receivable (AR)- to identify root causes, surface underpayments, reduce leakage, and improve net patient revenue (NPR) performance across the enterprise.
Rather than isolated revenue cycle tools, Bloom coordinates intelligence across departments so that improvements in denial prevention, managed care contract performance, coding accuracy, and collections reinforce one another over time.
Through AI-enabled analytics, coordinated AI agents, and revenue cycle domain oversight, Bloom helps hospitals protect revenue, improve predictability, and drive sustainable financial performance across the enterprise.
Identify denial patterns before they escalate.
Streamline denial workflows and reduce manual rework.
Monitor payer performance and reimbursement behavior trends.
Improve AR velocity and collections visibility.
Aiden
Coordinates the end-to-end denials lifecycle — prioritizing high-value cases, routing work queues, tracking deadlines, and improving overturn rates to protect net patient revenue.
Maya
Monitors RCM systems and payer portals for denials, retrieves EOBs, and flags claims for appeal to ensure timely action and minimize AR aging.
Ethan
Conducts claim-level clinical validation against payer medical necessity criteria and generates evidence-based appeal recommendations.
Leah
Produces payer-aligned appeal letters informed by claim data, clinical documentation, and Bloom’s proprietary framework.
Owen
Automates appeal packaging and submission across payer portals, ensuring documentation completeness and audit readiness.
MAX
A conversational revenue cycle intelligence assistant providing immediate, data-driven answers across denials, AR, contracts, coding, and reimbursement — eliminating dashboard navigation.