Our risk adjustment solutions can help you achieve your goals.

For government-sponsored health plans, effective Medicare risk adjustment and Medicaid risk adjustment strategies are essential.

Achieve more accurate and timely risk-adjusted payments.

Our comprehensive suite of risk and quality solutions help you identify opportunities for more accurate, complete CMS submissions.

Improve Care Quality and Increase Revenue with Change Healthcare Analytics Center.
 

We pair our industry-leading risk adjustment models with ongoing support, superior analysis, and score gap interventions to help you meet compliance guidelines and achieve your revenue and quality goals.

Risk Adjustment Analytics

Risk View™: Optimize Your Strategy With Risk Adjustment Analytics

Monitor risk score trends and related metrics, such as percentage of members with HCCs, average risk score, and expected risk score (gaps) at the member and provider level.

CMS Submissions

Encounter Complete™ and Edge Complete™: Maximize CMS Acceptance Rates to Speed Reimbursements

Our comprehensive, web-based SaaS solution provides CMS data submission services and error management, with a 98-99% acceptance rate.

HEDIS Analytics

Compliance Reporter: NCQA-Certified HEDIS® Reporting, CMS Quality Measures, and Workflow Tool

Optimize medical record abstraction by generating samples and chases, with real-time hybrid recalculation.

Realize Better Outcomes With Prospective Risk Adjustment
 

Our prospective risk adjustment solutions predict emerging patient-specific needs and diagnoses to help you drive highly targeted interventions for the right members at the right time. Achieve greater risk capture with collaborative engagement strategies.

Provider Alerts for Diagnosis Codes

Dx Gap Advisor™: Capture Missing Diagnostic Codes Before Claim Adjudication

Engage providers within their existing billing workflow by flagging potentially missed risk adjustment diagnosis codes for an opportunity to update the claim before submission.

Provider Alerts for Clinical Care

Care Gap Advisor: Present Actionable Insights in the Providers’ EMR

Alert providers of suspected risk gaps to help them capture more conditions during the clinical encounter.

Member Communications

Smart Connect™: Improve Engagement and Health Outcomes

Deliver targeted messaging, from wellness check reminders to disease education, to encourage proactive choices and improve member health.

Appointment Scheduling

Smart Appointment Scheduling™: Proactively Engage Members to Reduce Care Gaps

Use our live health advocates to faciliate provider appointments and close risk gaps with targeted member populations.

Dual Eligible Services

Dual Enrollment Advocate™ and Recert Complete®: Optimize Dual Enrollments with AI and Behavioral Science

Leverage AI to identify more dual-eligible members in your MA population. We take a menber-centric approach to faciliate enrollment and support yearly recertification.

Medicare Part D Enrollment

Part D Complete™: Help Members Enroll in Medicare Part D

Provide a Part D eligibility check and facilitate the application process for members who need assistance.

Social Determinants of Health Support

Community Advocate™: Meet Member Needs to Improve Health Outcomes

Use our advanced analytics to identify members in need. Rely on our concerierge service to help them find and enroll in community support programs.

Overcome Retrospective Risk Adjustment Challenges in This New Era
 

We use innovative technology to identify, pursue, and validate risk diagnoses on the medical chart that weren’t properly or fully captured before adjudication, utilizing electronic data capture and NLP-enabled coding.

Medical Record Retrieval

Medical Record Retrieval: Maximize Yield With Advanced Analytics and Electronic Retrieval

We help you identify charts with the highest propabability for additive HCCs. Our comprehensive chart retrieval service captures more medical charts while nurturing your provider relationships.

Risk Adjustment Coding

Risk Adjustment Coding: Capture More Risk Codes With Natural Language Processing

Detect coding variations with an average of >95% correct risk category identification, resulting in 20-30% increase in risk capture.

Medical Record Abstraction

Clinical Abstraction: Prioritize Charts for Optimal Results

We’ll help you optimize the management of your quality-related data for HEDIS® and CMS Stars through enhanced retrieval and rigorous quality control.

Gain new insights into risk adjustment best practices:

Talk to one of our experts today.