Commercial Market

Serving Commercial and Marketplace Exchange Health Plans

Our Approach

As a quality, care and revenue management solutions partner, Altegra Health empowers Commercial and Marketplace Exchange health plans to integrate key areas of financial performance and continuity of care while improving the quality of life of the individuals they serve. Implementation of the Affordable Care Act’s Market Reform Rules is rapidly transforming the commercial/exchange market. Success under reform requires an emphasis on:

  • Accurate eligibility, claims, and coding data
  • Risk intelligence under the new Hierarchical Condition Category (HCC) risk model
  • Member engagement, assessment, and retention
  • Provider engagement and incentives
  • Precise medical management

Altegra Health’s integrated suite of services assists health plans find success with these requirements through:

  • Data transformation and submission, risk analytics, and payment transfer reconciliation
  • Diagnosis and procedure coding and primary data validation audit support
  • Member onboarding, engagement, and retention
  • Provider engagement and support
  • Care management and medical cost reductions


Risk Adjustment

Continuous monitoring and reporting of risk scores to ensure members are appropriately risk-adjusted and, in turn, qualify for appropriate payment.

Quality Performance

Our Quality Performance solutions provide continuous member engagement and quality measurement tools to ensure appropriate and satisfactory levels of care. They include:

Program Assistance

Continuous monitoring of social program eligibility and enrollment status to ensure appropriate access to benefits for which members are entitled.

Reimbursement & Advisory Services

Our Reimbursement & Advisory Services Division has served as a trusted advisor to some of the nation’s most prominent healthcare organizations and health law practices, delivering proven, forward-thinking solution and real results. They include: