CASE STUDY

Improving Clinical Coding Accuracy for a US-Based Healthcare AI Platform

Enterprise AI validation layer deployed to correct model drift, improve ICD accuracy, and ensure compliance in claims processing workflows.

99%

ICD Coding Accuracy

22%

Clinical Accuracy Improvement

6 → 2 Weeks

Audit Cycle Reduction

Healthcare

Industry

The Challenge

  • 14% increase in incorrect ICD-10 recommendations
  • Rising clinician override rates
  • Escalating false positive clinical risk flags
  • Inconsistent documentation traceability
  • Internal HIPAA compliance concerns

Customer Overview

A US-based healthcare AI platform used a clinical risk prediction model (XGBoost) to automate claims processing and ICD coding.

As deployment expanded across hospital networks, demographic shifts caused model drift, leading to accuracy issues, compliance risks, and increased manual overrides.

DXW’s Approach

  • Deployed enterprise AI validation layer focused on clinical accuracy
  • Integrated validation within ICD workflow checkpoints
  • Applied RLHF-based dataset refinement for continuous improvement
  • Enabled HIPAA-aligned audit traceability

Validation Team

  • Certified medical coding specialists
  • Healthcare documentation reviewers
  • Clinical risk scoring validators
  • Domain experts aligned with ICD-10 compliance frameworks

Business Outcomes

81% → 99%

ICD Coding Accuracy

18% → 11%

False Positive Reduction

26% → 18%

Clinician Override Reduction

Continuous

Drift Monitoring

6 → 2 wks

Audit Preparation Time

100%

Traceable Compliance

Metric Before DXW After DXW
ICD Coding Accuracy 81% 99%
False Positive Coding 18% 11%
Clinician Override Rate 26% 18%
Drift Monitoring Quarterly Continuous
Audit Preparation 6 weeks 2 weeks
Compliance Traceability Moderate Fully traceable

“DXW transformed clinical AI validation from a periodic audit function into a continuous governance layer, enabling scalable deployment with measurable accuracy improvements and full regulatory defensibility.”