Risk Adjustment Programs & Program Management

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Risk Adjustment Programs & Program Management

Comprehensive and Balanced Risk Adjustment Solutions

Advantasure’s comprehensive risk adjustment program can help you achieve accurate, complete and compliant risk score accuracy.

A key aspect to assuring success is to assure proper payment for the population you are managing.   The proven path to achieve proper payment includes strategies that ensure complete and compliant CMS submissions, robust suspecting and reporting analytics, targeted member chase lists, comprehensive and consistent provider engagement and education, medical record retrieval and retrospective coding and member engagement strategies focused on getting members the care they need from qualified health care providers.   Without the right strategy and programs in place, health payers and risk sharing providers could experience liability associated with non-compliance, lost or missed revenue, increased expenses, member and/or provider abrasion. Creating an integrated, end-to-end risk adjustment program can seem like a monumental task, but with the right expertise, a seamless implementation is within reach.

Collaboration Drives Results

That’s where Advantasure comes in. Piece by piece, our team of industry experts eliminates the guesswork surrounding risk adjustment and provides a clear path forward to a tailored program designed to meet your unique goals. We dig deep into member profiles and provider performance to conduct condition-specific analysis and create accurate, effective outcomes. Then, we combine our innovative platforms with expertise and proven strategies to accelerate these results:

  • Target the right member at the right time
  • Drive provider engagement & education
  • Assure contact between your members and their health care providers
  • Work with providers to assure accurate documentation and billing practices
  • Support your organization increase compliance
  • Help you gain the competitive edge in the marketplace while improving your population’s health outcomes

For optimal efficiency across plan operations, you can bundle our risk adjustment program with our quality, administrative and care management solutions to further enhance your ability to leverage our capabilities.

Program options available to find the solution to fit your needs

  • Bid process input
  • Data-driven strategy development
  • Value and cost projections
  • Member risk adjustment gap identification
  • Provider performance, education and reporting
  • Prospective and retrospective initiative execution and management
  • In-home assessments
  • RAPS and EDPS submissions, error correction and reconciliation
  • RADV risk mitigation and audit support
  • Performance management reporting

Advantasure manages over $7 billion in risk-adjustment-related revenue for clients.

Working hand-in-hand with our clients, Advantasure partners with you to develop the winning risk adjustment program. Our expertise, combined with our cutting edge technology, products and services will provide you the advantage in your market place.  The strategies that we’ve created, and the new innovations we are rolling out each year, have given us a risk adjustment platform that is second to none.

Find Out How We Fuel Accelerated Performance

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