Submit accurate and timely data. Improve revenue. Impact quality of care. All in an efficient, proactive, and compliant manner
RISK View™, our advanced risk adjustment technology, combined with ongoing support, analysis, and score gap interventions help our partners proactively improve revenue and the quality of care while meeting compliance guidelines.
Altegra Health’s Risk Adjustment & Audit solutions provide software, analytics, and support services to identify risk adjustment factor (RAF) score gaps and prioritize resources used for risk adjustment activities. Our flexible risk adjustment platform lets healthcare organizations analyze risk scores based on specific risk adjusted model Hierarchical Condition Categories (HCCs) defined by the Centers for Medicare and Medicaid Services (CMS) for Medicare and ACA-Commercial models, and state-based Medicaid programs.
Extending beyond claims data analytics, our advanced analytic engine incorporates alternate data sources, such as pharmacy and care management data, to identify all possible risk gaps. We include analytic support and risk adjustment expertise to interpret risk score trend data and create the most effective prospective and retrospective risk adjustment strategy.
Our extensive team of risk adjustment experts and coding specialists facilitate – medical record retrieval, review those charts, and capture appropriate diagnoses and procedure codes for both retrospective and concurrent coding. In addition, we offer health plan and provider group coding and audit management to create a sustainable revenue cycle solution.
- Risk Score Trending – Monitor risk score trends and related metrics such as percentage of members with HCCs, average risk score and expected risk score (gaps) at the member and provider level.
- Data Transparency – View all risk adjusting data for members and providers, including claims, coding results, assessment data, provider diagnosis distribution and more.
- Advanced Analytics & Targeting – Examine retrospective and prospective targeting lists using demographic data, pharmacy data, self-reported conditions and care management information. For partners utlizing our chart retrieval and coding services, or member engagement solutions, chase lists and coding results are integrated.
- Risk Project ROI – Review and value project results within our RISK View™ platform, as well as reporting analyses results, including projected and final ROI.
- Supplemental Submission Analytics – Enjoy sophisticated analytics support decision-making and file creation for RAPS submission, EDPS coding project submission Edge server supplemental claim matching and, where permitted, Medicaid state-specific submission requirements.
- Counterparty Data Submission Comparisons – Filter data and screens based on accepted data from third parties when accepted encounters and claims (RAPS, EDPS, Edge server and when available, state Medicaid) are ingested.
- Flexible Reporting – Use analytics software to self-generate custom analytics. In addition, access numerous standard reports, including: score summary, member and provider targeting, member diagnosis history, payment summaries and CMS reports.
- Transparency – Examine the details and customize suspect targeting, financial and analytical reporting to meet your specific market needs.