Upon identifying each potential gap between enrollee clinical conditions and requisite dataset documentation (each an enrollee reimbursement improvement opportunity), the CARA™ system is unique in its ability to generate and report respective potential financial impact, verification probability, and a return-on-investment threshold variance. The potential financial impact reflects the risk adjustment or factor improvement in precise annual financial terms. The verification probability provides insight into the likelihood of being able to properly confirm and substantiate the enrollee’s medical conditions appropriately for CMS, state-based, or commercial program reimbursement. The return-on-investment variance threshold aids in guiding MedAssurant and its clients in determining which improvement cases should be pursued – avoiding inappropriate chasing of low yield or low likelihood improvements seen often in alternative solutions. These and other powerful threshold tools enable the MedAssurant CARA™ system to deliver not only superior healthcare data quality and reimbursement improvement capabilities, but also unprecedented controls on cost and return-on-investment threshold goals to its health plan clients.