Cybexys

Cybexys, Inc., founded in 2016 by Raul Kivatinetz, operates within the healthcare technology sector, focusing on financial risk adjustment and revenue cycle management. The company is headquartered in Las Vegas, United States. Its establishment addresses a critical inefficiency in the U.S. healthcare system: systemic underpayment and fund misallocation due to inaccurate diagnostic coding from provider documentation.

The firm's core offering is CARAT™, an expert system that leverages artificial intelligence to optimize this process. The platform serves a specific client base, including Medicare Advantage plans, Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and health plans on the ACA Marketplace. Cybexys generates revenue by providing its technology solution to these risk-bearing organizations, helping them accurately capture patient risk scores and, consequently, secure appropriate reimbursement from federal and state governments. A seed funding round was completed on November 27, 2017, with investors including Startupbootcamp, Sopris Capital, and Kormeli.

CARAT™ integrates directly into a provider's Electronic Health Record (EHR) system, using a combination of Natural Language Processing (NLP), Optical Character Recognition (OCR), and machine learning. This technological stack allows it to analyze both structured and unstructured clinical data, including text notes, PDFs, and image files. The system works prospectively, providing real-time feedback during a patient encounter. It flags documentation and coding omissions, allowing providers to make corrections concurrently, which helps ensure compliance with M.E.A.T. (Monitoring, Evaluating, Assessing, Treating) criteria. By automating retrospective reviews and suggesting ICD-10 and HCC codes with up to 95% accuracy, CARAT™ aims to reduce the administrative burden on clinicians, decrease the risk of costly audits, and prevent revenue loss.

Keywords: risk adjustment, healthcare finance, revenue cycle management, clinical documentation improvement, medical coding, health-tech, AI in healthcare, natural language processing, machine learning, Medicare Advantage, value-based care, HCC coding, diagnostic codes, risk score accuracy, EHR integration, MCO, ACO, claims data analysis, RADV audit, prospective review, healthcare analytics, provider solutions