Risk Analytics & Reporting

Improve revenue and quality of care with an advanced analytics engine

Our advanced risk adjustment technology, combined with ongoing support, analysis, and score gap interventions help our partners improve revenue and the quality of care in a proactive and efficient manner. We support these services through an extensive team of experts and coding specialists who retrieve medical records, review those charts, and capture appropriate diagnoses and procedure codes. In addition, we offer health plan and provider group management and submission services to create a sustainable risk adjustment solution.

Altegra Health’s Risk Reporting & Analytics solutions provide software, analytics, and reports to identify risk adjustment factor (RAF) score gaps and prioritize resources to more effectively care for healthcare organization members. Our flexible risk adjustment platform lets healthcare organizations analyze risk scores based on the 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 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 health plan clients can deploy any combination of our risk adjustment interventions to create a sustainable risk adjustment solution, including medical record coding, health risk surveys, provider office visit scheduling assistance, and home assessments.


  • Member Level Details – Review claim, diagnosis and risk score trends and gaps for all members by plan and provider group.
  • Provider Level Analytics – Evaluate risk score trends and  improvement opportunities by provider group and their corresponding members.
  • Advanced Analytic Suspect Targeting –  Analyze demographic data, pharmacy data, self-reported conditions and care management information to create a comprehensive suspect algorithm, beyond historical probability analytics.
  • Value Analysis – Calculate a projected and realized ROI for each intervention project, retrospective or prospective.
  • Flexible Reporting – Access software that includes a wide array of trending and financial reports, including the ability to self generate analytics.
  • Transparency – Examine the details and customize suspect targeting and analytic reporting to meet your specific market needs.