ELEVATE! Risk Adjustment Analytics’ clinically derived analytics combine advanced suspecting and targeting, probability trend analysis, and coding gap intervention to provide health plans and provider groups with a comprehensive risk adjustment solution.
COMPREHENSIVE AND ACCURATE SUSPECTING
Clinical mapping reduces false positives during suspecting due to the mapping of acute versus chronic conditions at the ICD-10 level. Data is captured from multiple sources to identify chronic conditions that require intervention.
Data sources include:
- Physician Record Reviews
- Member Data
- Provider Data
- CMS Files
- Supplemental Data
- Member Records/EMR
INTELLIGENT AND AGILE TARGETING
Sophisticated targeting allows clients to analyze risk scores based on specific Hierarchical Condition Categories (HCCs). A proprietary analytic engine cleans, maps, and validates data for importing into the Advantmed warehouse.
SUMMARY OF THE ELEVATE! RISK ADJUSTMENT ANALYTICS END-TO-END 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 financial impact in real-time
- Identify service gaps and documentation gaps from coding
- Member and provider engagement services to close gaps
Advantmed incorporates ELEVATE! Risk Adjustment Analytics into our ELEVATE! platform, providing ongoing insights to understand the drivers of medical and financial risk.