RafCite™

Purpose-Built for Medicare Advantage Compliance

RafCite™ is on-premise chart review software designed for Medicare Advantage plans. It processes medical records, evaluates each HCC code against MEAT criteria (Monitoring, Evaluation, Assessment, Treatment), and produces a structured, citation-backed report for your coding and compliance team.

Under 5 minutes per chart versus 3–4 hours manually. All processing runs inside your infrastructure — no patient data is transmitted to any external system.

Key Capabilities

• 1
  On-Premise Deployment Runs on hardware you control. Containerized components with no external egress. Your infrastructure, your security posture.
• 2
  MEAT Evidence Extraction Each HCC evaluated against all four MEAT criteria — Monitoring, Evaluation, Assessment, Treatment — with exact source sentence citations from the underlying medical record.
• 3
  ICD-10 to HCC Mapping Native HCC V28 and V24 support with RAF weight lookup and hierarchy exclusion enforcement. Supports multi-year cross-walk analysis.
• 4
  Audit-Ready Output Structured report flags each HCC as Supported, Needs Review, or Unsupported — with full provenance linking each finding to its source sentence and document location.
• 5
  Reviewer-in-the-Loop Every output requires human confirmation. RafCite™ assists your coders and compliance staff — it does not make final coding or billing decisions.
• 6
  Zero PHI Egress Network access disabled at the environment level, not by configuration alone. Chart content is never transmitted to any external service for MEAT analysis or ICD resolution.

Performance Metrics

Metrics from internal validation on held-out charts not used in training. Independent clinical review available upon request.

Zero-Egress Architecture

RafCite™ is designed from the ground up to keep patient data inside your environment. Each processing stage is isolated and independently verifiable.

• 1
  Document Processing OCR runs in an isolated container inside your environment. No chart content is transmitted externally at any stage of document ingestion or text extraction.
• 2
  Clinical NLP Inference The proprietary MEAT classifier runs entirely in-process on your hardware. Network access is disabled at the environment level — not by application-layer configuration alone.
• 3
  ICD Code Resolution (Optional) A local language model handles ICD fallback lookup. Disabled by default. When enabled, it operates entirely on-premise and never reads chart content for MEAT analysis.

Who It's For

• Medicare Advantage Plans Managing RADV audit exposure and seeking defensible, citation-backed documentation evidence for submitted HCC codes.
• Risk Adjustment Teams Conducting pre-audit chart reviews to identify documentation gaps before CMS submission or audit cycle begins.
• Compliance Officers Needing structured, provenance-rich evidence packets that demonstrate due diligence in HCC documentation review.
• Health Plan Coders Reviewing complex or high-value HCC codes where thorough MEAT documentation review is required before sign-off.

What RafCite Does Not Do

• ✕
  Does not submit claims or modify systems of record RafCite™ produces review reports only. It does not connect to, write to, or modify any claims system, EHR, or coding platform.
• ✕
  Outputs require qualified human review All outputs are decision-support tools. Review by a qualified coder or compliance professional is required before use in any claim submission, audit response, or other consequential action.
• ✕
  Not operated by Cast Net Technology on your behalf RafCite™ is not a cloud or SaaS service. Cast Net Technology does not operate or host RafCite™ for customers — it runs entirely inside your infrastructure.
• ✕
  Does not guarantee audit outcomes or claim accuracy RafCite™ does not guarantee that any HCC will pass a RADV audit or that any claim is accurate. Regulatory requirements change; the software may not reflect the most current CMS guidance at any given time.

Explore RafCite Solutions

RafCite powers a range of compliance workflows for Medicare Advantage organizations: