AtlantiCare Enhances HCC Coding with Premier’s Stanson Health CodingGuide, Driving Quality and Efficiency

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Key Takeaways:

• AtlantiCare aimed to improve the accuracy of their Hierarchical Condition Category (HCC) coding. This would allow them to more effectively assess patient risk and secure appropriate value-based care reimbursements across their extensive network.
• AtlantiCare implemented Premier's Stanson Health's CodingGuide solution, which provides real-time inference and revalidation of HCC codes in the provider workflow.
• The CodingGuide implementation helped to significantly improv risk stratification and enhance overall patient care, all while streamlining operations and minimizing disruption.

AtlantiCare, the largest healthcare provider in southeastern New Jersey, has always been at the forefront of delivering high-quality care. Its expansive network includes over 110 ambulatory locations, two hospitals and various urgent care centers and health parks. However, as AtlantiCare embarked on Vision 2030, its ambitious six-year strategy - focused ontransforming the way healthcare is defined, measured and delivered - the team encountered significant hurdles with Hierarchical Condition Category (HCC) coding.

"We experienced challenges with HCC codes not being added at the expected amount or levels to patient charts," said Victoria Rose, MD and Medical Director of Primary Care at AtlantiCare. "This is critical, as it impacts resource allocation as well as the ability to quantify overall patient illness severity and obtain value-based care reimbursements. We knew we had to find a quick solution."

AtlantiCare's leadership team recognized that these coding inefficiencies could hinder its progress toward the goals outlined in their Vision 2030 plan. The stakes were high - not only in terms of financial reimbursement but also in ensuring accurate risk stratification, operational efficiency and optimal patient care.

Navigating Coding Challenges with CodingGuide

To overcome these issues, AtlantiCare implemented Premier's Stanson Health CodingGuide, a cutting-edge tool designed to help streamline and enhance the HCC coding process. CodingGuide enhances HCC coding by offering real-time alerts for providers in the workflow and at the point of care. This innovative solution shifts from traditional retrospective recapture to real-time revalidation, ensuring that HCC codes reflect the most current clinical data.

"Providers could easily identify potential missing or outdated codes using CodingGuide, allowing them to make real-time updates," Dr. Rose said. "This tool has fundamentally changed how we approach coding, giving us the ability to identify and address issues earlier."

Engaging Providers: Building Trust through Communication

Introducing CodingGuide to AtlantiCare's wide provider network required careful planning and communication. From the outset, Premier proved to be more than just a software provider - they were true partners in the transformation.

"They mapped out a plan with meticulous detail, reached every milestone on the timeline, addressed every question promptly and provided resources to augment this initiative," said Edward Fog, DO, Vice President and Chief Medical Officer, AtlantiCare Health Network. "We were expecting a heavy lift to get this off the ground, but that wasn't the case."

Months before the go-live date, AtlantiCare introduced CodingGuide to their team, emphasizing the urgent need for improved coding with concrete data. Detailed timelines were shared, and providers received consistent updates throughout the implementation process. "Every provider who received an alert was contacted to ensure they understood it," said Dr. Fog. "We tracked rates of ignored alerts to make sure providers knew how to properly close them."

The CodingGuide Impact on Quality and Efficiency

CodingGuide has had a profound impact on AtlantiCare. Today, the tool enables AtlantiCare providers to swiftly identify and correct potential coding discrepancies. This accuracy-driven approach helps providers identify, confirm or update HCC codes based on current clinical data. Capturing all relevant HCC codes has been pivotal in improving the accuracy of patient records, directly contributing to better risk assessment and more appropriate reimbursement. As a result, AtlantiCare can now make more informed care decisions with up-to-date data, which ultimately may drive better patient outcomes - all while making chart reviews less time consuming.

"Since implementing CodingGuide, we've seen an increase in coding accuracy and a reduction in time spent on chart reviews," Dr. Rose noted. "This has significantly improved our risk stratification processes, which will ultimately contribute to better patient outcomes and fair reimbursement."

Provider feedback has been positive, with many appreciating the simplicity and efficiency of the CodingGuide interface. "Providers have been supportive, particularly since the program requires only one to two clicks compared to other systems that demand much more," said Dr. Rose.

The user-friendly design, coupled with comprehensive training, minimized resistance and facilitated a smooth transition to the new system. "The transition to CodingGuide was seamless, and the real-time alerts have been invaluable," said Dr. Rose. "I can quickly address potential coding issues without disrupting my workflow, which ultimately benefits my patients."

Results at a Glance

Following full deployment of CodingGuide across the AtlantiCare network, Calendar Year 2025 data confirm transformational results in HCC coding accuracy, provider engagement and revenue impact.

• 4,338 HCC coding opportunities identified - encompassing recapture, revalidation and inferred conditions - across the contracted MSSP and Horizon BCBS populations.
• 5,245 alerts fired across 48 clinical guidelines, with 1,333 opportunities closed (31 percent closure rate).
• 63 percent average alert follow rate - one of the highest recorded among providers using the technology - with 331 providers adding at least one HCC code.
• $5.9 million in potential revenue impact for contracted plans (assuming $800 PMPM), driven by more precise risk adjustment. Top contributors include Morbid Obesity ($2.9 million), Diabetes with Chronic Complications ($1.2 million) and COPD/Chronic Lung Disorders ($371,000).
• 69 percent of all CodingGuide alerts at AtlantiCare perform above the Premier median, with high-volume conditions such as obesity, diabetes and CKD consistently posting the strongest follow rates.

In 2026, AtlantiCare's momentum continues to build. In January, alert volume increased while the follow rate climbed to 68 percent - a clear signal that provider adoption is deepening even as the program scales.

Continuing the Coding Journey

AtlantiCare plans to continue leveraging advanced tools and technologies to redefine healthcare delivery in their region and beyond.

As AtlantiCare looks to the future, they are committed to sharing their experiences and best practices with other healthcare organizations. "We believe that by working together and sharing what we've learned, we can help drive positive change across the entire healthcare system," Dr. Rose said.

For more:

• Discover what a partnership with Premier's Stanson Health and CodingGuide can do for your healthcare organization.