Our risk adjustment solutions can help you achieve your goals.
For government-sponsored health plans, effective Medicare risk adjustment, Medicaid risk adjustment, and ACA risk adjustment strategies are essential.
Our comprehensive suite of risk and quality solutions help you identify opportunities for more accurate, complete submissions.
Monitor risk score trends and related metrics, such as percentage of members with HCCs, average risk score, and expected risk score (gaps) at the member and provider level.
Our comprehensive, web-based SaaS solution provides data submission services and error management, with a 98-99% acceptance rate.
Optimize medical record abstraction by generating samples and chases, with real-time hybrid recalculation.
Engage providers within their existing billing workflow by flagging potentially missed risk adjustment diagnosis codes for an opportunity to update the claim before submission.
Alert providers of suspected risk gaps to help them capture more conditions during the clinical encounter.
Deliver targeted messaging, from wellness check reminders to disease education, to encourage proactive choices and improve member health.
Use our live health advocates to faciliate provider appointments and close risk gaps with targeted member populations.
Leverage AI to identify more dual-eligible members in your MA population. We take a menber-centric approach to faciliate enrollment and support yearly recertification.
Provide a Part D eligibility check and facilitate the application process for members who need assistance.
Use our advanced analytics to identify members in need. Rely on our concerierge service to help them find and enroll in community support programs.
We help you identify charts with the highest propabability for additive HCCs. Our comprehensive chart retrieval service captures more medical charts while nurturing your provider relationships.
Detect coding variations with an average of >95% correct risk category identification, resulting in 20-30% increase in risk capture.
We’ll help you optimize the management of your quality-related data for HEDIS® and CMS Stars through enhanced retrieval and rigorous quality control.