RISK ADJUSTMENT SOLUTIONS
Enabling superior risk score accuracy and patient care through integrated data, technology, analytics and clinical operations

While Risk Adjustment has increased in complexity from both regulatory and operational perspectives, the goal remains simple—accurately capture and report members’ risk adjustable diagnosis codes in order to identify gaps in care and receive proper payment from CMS. Advalent’s fully integrated, end-to-end Risk Adjustment solution helps healthcare organizations on their journey towards delivering value-based care, provides significant ROI through improved processes and accurate reimbursement, and facilitates stronger member and provider relations through proven collaboration models.

From suspect condition identification that drives gap closure initiatives through configurable encounter data submissions to CMS (Medicare and Exchange) and state (Medicaid) entities, Advalent ensures payers keep compliant with all federal and state regulatory requirements and risk scoring methodologies. With our advanced RISK360 analytics, payers can identify probable undocumented Hierarchical Condition Category (HCCs) in order to improve patient care and drive revenue through clinical interventions such as Medical Record Retrieval, Provider Education and Encounter Facilitation (Office Visits or Home Health Assessments). Our approach is designed to include overlooked chronic conditions, worsening disease state, unconfirmed diagnosis, labs and prescription fills, as well as various other clinical/utilization markers to assess the complete member condition. Additionally, Advalent’s Risk Adjustment solution is EMR-ready and utilizes our proprietary EMR-Connectors to automatically extract the targeted DOS from EMR systems to drive risk score improvement on a near real-time basis.

Click a Risk Adjustment solution icon below to learn more:
  • Suspect Analytics

  • Medical Coding

  • Medical Record Retrieval

  • Provider Education Programs

  • RAPS/EDS/Edge Server Submissions

  • Prospective Provider Operations

Client Benefits
Improve your risk adjustment and revenue outcomes with our SMAART technology
  • Improved Risk Score Accuracy and Payments
  • Increased Member Satisfaction
  • Cost-Effective Medical Record Retrieval
  • High Acceptance Rate for Encounter Data Submission
  • Increased Coder Accuracy
  • Improved Provider Performance