Risk View is the risk adjustment software platform used by healthcare insurers to understand risk score trends and opportunities, help drive financial results, and optimize targets for appropriate risk-adjusted reimbursement.
What’s included in Risk View™
Risk adjustment software and strategy tools
- Drive financial results
- Understand financial goals
- Comply with operating requirements
- Help ensure score and payment accuracy
- Manage the RAPS to EDS transition and compliance analytics
Targeted advanced risk analytics
- Proprietary predictive risk modeling software
- Includes risk adjustment, quality, socioeconomic, and other related data
- Helps identify member gaps and create targets
Risk adjustment activity management
- Leverage our experienced account management team
- Get a dedicated program manager
- Utilize leadership to optimize risk adjustment activities
Help improveyour risk adjustment outcomes
Comprehensive reports to inform strategic planning
Get a comprehensive end-of-year and end-of-project risk adjustment plan profile for informed strategic planning. Our program flexibility identifies both retrospective and prospective intervention activities at varying cost levels to help achieve outreach objectives. Our advanced models use artificial intelligence, big data, and intelligent chart selection across significantly large data assets to target most appropriate members.
Risk adjustment software to help increase accuracy
Use our risk adjustment software to help increase accuracy of provider documentation, coding, and billing to increase provider engagement, helping to achieve quality and financial goals. Optimize reimbursements through the most effective and efficient targets.
Insight to comply with requirements and regulations
Get financial insight in advance of CMS. Use our risk adjustment software to track and predict CMS payments by source data analysis and forecasting with accepted vs actual CMS calculated scores previews payments report. Plus, our RAPS to EDS transition management planning provides insight to future risk score impact and projected payments.
Robust summaries to see the full picture
Standardized and customized robust reports include data on risk score summaries, category distribution, member categories, and provider diagnoses to show risk score trends, population insights, and coding behavior. Our easy-to-use dashboard gives key metrics to support financial incentives and goals. Help increase provider engagement to help achieve quality and financial goals.
Providing Measurable Value
targeting analytics ROI for Medicaid Advantage plans (maximum result)
risk score increase for ACA plans (maximum result)
supported insurers in covering nearly 2 million enrollees
Need support for
- Encounter Complete™ Learn how our encounter data analytics platform helps payers handle systematic processing of error management, interpretation, and reconciliation. Learn more
- Dx Gap Advisor™ Learn how our analytics-driven risk adjustment review solution helps to support diagnosis coding accuracy, streamline billing workflow, and close risk gaps. Learn more
- Edge Complete™ Learn how our data lifecycle claim management solution helps meet ACA Edge Server requirements with streamlined workflows, status reporting, and timely delivery. Learn more
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