Risk Adjustment Analytics

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:

  • Screenings
  • Physician Record Reviews
  • Claims
  • Pharmacy
  • Laboratory
  • 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.

Learn how Advantmed can help you.