We help health plans and risk-bearing providers improve outcomes across their risk adjustment and quality programs.
Never miss a reimbursement opportunity: incomplete, incorrect, or missing claims data impacts your reimbursements. Trust our proven claims data validation process and detail-oriented experts.
Our in-house coding specialists take a thorough approach starting with blind coding. From there, we run the results through our advanced data and claims validation engine to confirm coded conditions, identify impactful adds, and flag potential deletes. For added accuracy, we also perform a tertiary review on all deletes.
Our in-house claims validation team confirms that each claim’s documented HCCs are supported in the medical record. This reveals any incomplete, incorrect, or missing data before it’s submitted.
We take your claims data and map all diagnostic codes to HCCs to ensure accurate risk adjustment scores. This process accounts for all versions of risk adjustment models that apply, including V24 and V28 for Medicare Advantage.
We conduct a thorough review and blind code the chart, matching clinical data back to the claims data for enhanced due diligence and accuracy. This approach offers a view of each provider’s coding patterns and their impact on risk adjustment.
We report any unsupported HCCs back to you as unconfirmed, so you can take appropriate action. This includes detailed information on documented conditions with identified flaws, captured through Clinical Documentation Improvement (CDI).
