Risk Adjustment

ELEVATE! Risk Adjustment InsightsTM is Advantmed’s comprehensive risk adjustment solution for health plans, managed care organizations and other risk-bearing entities.

The revenue optimization process begins with our risk analytics engine, which calculates historic and potential risk scores and determines suspected morbidities leading to both revenue optimization and cost containment opportunities. Uniquely, the ELEVATE! Risk Adjustment Insights solution builds off the information produced by our own ELEVATE! Risk Adjustment Insights risk analytics or the output from other risk analytics tools.

Advantmed incorporates ELEVATE! Risk Adjustment Insights into our ELEVATE! HealthcareTM platform providing ongoing insights to understand the drivers of medical and financial risk and the ability to take action to ELEVATE! Risk Adjustment Insights through the optimal combination of services such as medical record retrieval, medical record coding by certified coders, identification of documentation of service gaps and both member and provider engagement services that close those gaps.

Summary of ELEVATE! Risk Adjustment Insights, Advantmed's end-to-end risk adjustment solution

  • Fully-managed import of all key health plan data
  • Process data through all major risk models
  • Identify non-optimized members due to projected RAF scores or suspected morbidities
  • Specify chase logic for prioritization of medical record retrieval
  • Medical record retrieval services
  • Medical record coding services
  • Inferred coding
  • Monitor progress of coding project and revenue optimization activities in real-time
  • Identify service gaps and documentation gaps from coding
  • Member and provider engagement services to close gaps

Learn more about our solutions today.