Our secure cloud-based Clinical-AI Analytics service platform for Medicare Risk Adjustment provides advanced HCC analytics for health plans and provider groups, who are already submitting HCC risk adjustment data and desire a deeper level of insights and error analysis

We currently support all CMS-HCC, HHS-HCC models and Medicaid CDPS-Rx models, and provide custom solutions for accurate HCC recapture. Our platform supports all CMS file formats and our analytics team can provide custom reports to optimize your Risk Adjustment program

DATA CONSOLIDATION

ROBUST DATA MANAGEMENT

Extract, transform, and consolidate encounter data for submission to CMS, paired with operational reporting

CLAIMS TRANSACTIONS

STREAMLINED CLAIM TRANSACTIONS

Generate and submit clean claims transactions required for all encounter types (X12 5010 837 I, P, and DME)

CMS RESPONSES

DETAILED AND ACTIONABLE

Load and process CMS responses to claims transactions (TA1, 999, 277CA, MA-002, MA-004, MORs and others)

ERROR MANAGEMENT

RESOLUTION & CORRECTION

Get access to highly configurable and robust error queue management

ADVANCED HCC ANALYTICS

MACHINE LEARNING DRIVEN ANALYTICS

Clinical AI-based HCC rules engine to give more predictability into your HCC recapture and provides robust leverage to your prospective and concurrent Risk adjustment processes

ENCOUNTER SUPPORT

FULL-RANGE OF SUPPORT TOOLS

Support all variations of encounters including: standard, capitated, void and adjusted, chart linked and unlinked, and deleted, as well as encounters from atypical providers