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.
Drive financial results by understanding financial and operating goals and requirements.
Increase provider engagement to help achieve quality and financial goals.
Increase accuracy of provider documentation, coding, and billing.
Optimize reimbursements through the most effective and efficient targets.
Track and predict CMS payments by source data analysis and forecasting.
Ensure score and payment accuracy by managing the RAPS to EDS transition and compliance analytics.
Optimize Risk Score Improvement
Risk adjustment strategy tools
Accepted vs. actual CMS calculated scores previews payments report, giving financial insight in advance of CMS.
RAPS to EDS transition management planning provides insight to future risk score impact and projected payments.
Comprehensive end-of-year and end-of-project risk adjustment plan profile allows for informed strategic planning.
Targeted advanced risk analytics
Proprietary predictive risk modeling software includes risk adjustment, quality, socioeconomic, and other related data to identify member gaps and create targets.
Advanced models use artificial intelligence, big data, and intelligent chart selection across significantly large data assets to target most appropriate members.
Program flexibility identifies both retrospective and prospective intervention activities at varying cost levels to help achieve outreach objectives.
Risk adjustment activity management
Experienced account management team and dedicated program manager provide leadership to optimize risk adjustment activities.
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.
Easy-to-use dashboard gives key metrics to support financial incentives and 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