Results for Payer

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  • Case Studies

Risk Adjustment – Second Level Review: HHS-HCC score increased from 3.89 to 4.4 across ACA members

Client Background and Context National Health Plan with 3.5M+ members. The Fortune 500 client found gaps in their coding & claims data collection/submission process for a subset of their ACA population. The client wanted to ensure accurate & complete code capture with compliance and quality. Solution 2nd level review through ...Read More
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  • Case Studies

Internal Data & Audit Platform: 30% increase in productivity & 50% reduction in technology spend

Client Background and Context Client with 20+ risk-bearing locations & various data input sources wanted to: Partner with a platform to audit codes received from multiple sourcesImprove productivity of each of their locations & divisionsIncrease data quality of codes added by internal & external partnersEnhance operating margins through cost optimization Solution ...Read More
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