Risk Adjustment Solutions: Achieve superior risk score accuracy and financial performance
MedAssurant’s comprehensive Risk Adjustment solutions provide an industry-leading approach to the efficient determination and substantiation of disease and comorbid condition data delivering high return-on-investment improvements in reimbursement accuracy. Our clinically-driven algorithms leverage billions of known medical events to provide superior effectiveness in identifying gaps in assessment, documentation, and care.
Orchestrated through a proprietary logistical platform, necessary medical record data are digitized, abstracted, validated, and confirmed through a quality oversight processes. The result is a more thorough understanding of each member and a more comprehensive risk score value. MedAssurant stands ready to meet client needs from the provision of state required and CMS compliant Risk Adjustment Processing System (RAPS) and Encounter Data Submission (5010) file formats containing the confirmed member gap findings through providing targeted care coordination interventions.
Retrospective Risk Adjustment
Using logic-driven clinical algorithms, MedAssurant’s industry-leading Retrospective Risk Adjustment solution, historically known as CARA™ (capitated risk adjustment) identifies and validates incomplete or inaccurate claims data. Focusing on high financial yields, we identify, analyze, validate and submit, across various care settings, a client’s complete risk adjustment dataset. By going beyond what is captured in primary claims systems, we are able to provide superior identification of reimbursement opportunities. Setting us apart from other solutions, we consistently run risk adjustment analytics year-round in accordance with the CMS calendar and other state-based provisions to ensure maximum improvement in financial, clinical and quality outcomes.
Prospective Risk Adjustment
MedAssurant’s Prospective Risk Adjustment solution connects members with their physicians to proactively improve quality of care and risk score accuracy. Applying thousands of clinically-driven algorithms we are able to identify actionable gaps in care, documentation, quality, assessment, and risk score accuracy. Interventions are implemented systematically and strategically, focusing on diagnoses that will have the greatest impact on reimbursement and member care. MedAssurant facilitates significant financial value capture and care gap closure by coordinating the most appropriate interventions for identified members throughout the year.
Claims Aggregation, Analysis And Submission — CAAS™
MedAssurant’s CAAS™ solution facilitates accurate and timely financial analysis, submission, reporting, and forecasting across a client’s entire enrollee portfolio undergoing risk adjustment optimization.
Encounter Data Submission – eCAAS AdvantageTM
MedAssurant’s eCAAS Advantage™ solution provides a comprehensive claims processing and risk adjusted financial valuation solution to address CMS’s transition from RAPS-based submissions to the new 5010-format encounter data submissions.
Audit and RADV Support
MedAssurant helps health plans improve accuracy and reduce risk exposure with our suite of products to support RADV audits, Mock RADV projects, and ongoing HCC or state-based payment model surveillance and attestation initiatives.