- True end-to-end process solution – from receipt of raw native health plan data - to identification of high return-on-investment, reimbursement factor improvements, substantiating medical record review coordination, and provision of state-based or CMS-ready Risk Adjustment Processing System (RAPS) file documentation for claim submission, augmentation, or correction.
- Proprietary, clinically-driven algorithms designed to identify the complete spectrum of risk score and factor improvement opportunities, while intelligently stratifying these by probability, financial impact, and compliance with client-defined return-on-investment goals.
- Seamless, secure, and HIPAA-compliant data transfer and integration, accommodating client data in their native formats, relieving the need for clients to maintain intensive IT resources.
- Comprehensive clinical, technical, CMS, state, and audit support aiding clients in all aspects of the challenging capitation risk adjustment reimbursement process.
- Return-on-investment savvy solution focused on superior process support, risk score, and factor-driven reimbursement results while minimizing clients’ internal staff resource requirements, remaining absent of hidden costs, and avoiding the need for voluminous costly support hours.
- ChaseWise™, a field proven, chart chase logic system developed with physician clinical input and the analysis of over 3,000,000 medical record review chases and results, designed to optimize result findings and minimize unnecessary medical record reviews.
- Fully integrated medical record review and abstraction operations in all 50 states with hundreds of centralized data analysts, clinicians, review project managers, review schedule coordinators, and quality personnel - combined with hundreds more in-field clinical review nurses, data collectors, and certified medical coders.
- Dedicated quality department consisting of hundreds of clinical nurse and certified coder employees dedicated to overseeing and supporting in-field employee training, medical record reviewer inter-rater reliability, quality compliance and overall project accuracy.
- Unmatched results transparency, reporting, and progress tracking capabilities with extensive, 24/7 access to a broad array of rich reporting tools revealing not only cumulative and granular financial implication results, but also enabling insight into how to improve them.
- Powerful analytics leveraging client datasets to expand beyond risk adjustment reimbursement goals to deliver added value by providing powerful, synergistic bid preparation, quality improvement, factor optimization, HEDIS compliance, disease management, HRA, fraud and abuse, pay-for-performance, and granular market demographic intelligence solutions.
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