Risk Adjustment Solution Edifecs

Risk Adjustment
Clinical Suite

Complete and accurate risk capture is essential to success in value-based contracts. Effective risk adjustment can improve revenue accuracy, enhance care quality, and reduce compliance and audit risks—but achieving this is often easier said than done. Combing through mountains of clinical data requires time and resources that many provider organizations simply don’t have at their disposal.

The Risk Adjustment Clinical Suite is a SaaS-based, modular solution that seamlessly integrates with any EHR to augment—not undermine—existing clinical workflows. Using AI-derived insights and our proprietary Natural Language Processing (NLP) engine, the Clinical Suite enables provider organizations to achieve complete and accurate risk capture.

Risk Adjustment Clinical Suite: The Key to Value-Based Success

By delivering better satisfaction, better clinical outcomes, and better population health, value-based care can transform healthcare. Effective risk adjustment is essential to success in value-based care—but for many provider organizations, achieving complete and accurate risk capture is easier said than done.

It's Time to Work Smarter, Not Harder

We help providers streamline risk adjustment workflows for more accurate and effective risk capture. Get in touch to learn more.

Risk Adjustment Solution 1
  • Ingest and analyze clinical data from structured & unstructured sources
  • Flag risk-adjustable opportunities upstream in care delivery
  • Increase risk capture or recapture: +1 HCC per every ~5 patients reviewed

Cut through the noise

Leverage AI & NLP to identify and close care gaps, flag risk-adjustable opportunities, and reconcile data with HCC codes.

HCC Risk Adjustment 2
  • Maximize risk capture opportunities with proactive suspecting
  • Highlight the right clinical information for better care & patient engagement
  • Harness NLP-derived insights and incorporate them into existing provider workflows

Focus on what matters

Spend less time reviewing historical chart data and more time delivering high-quality care experiences for your patients.

Risk Adjustment in Healthcare 3
  • Enable compliance with AI-powered HCC coding reconciliation
  • Manage all risk-based contracts with one standardized risk capture process for all patient populations
  • Leverage Edifecs’ coding services to increase operational flexibility & productivity

Optimize risk adjustment workflows

Reduce organizational dependence on retrospective reviews by analyzing clinical data and reconciling it with HCC codes—before claims are submitted.

Medicare Risk Adjustment 4
  • Add an additional layer of oversight to minimize missed or improperly coded conditions
  • Reduce duplicative work and increase productivity by up to 400%
  • Highlight frequently miscoded conditions and act on provider education opportunities

Close the gaps

Utilize Edifecs’ market-leading NLP engine and machine learning (ML) technology to improve coding accuracy, revenue integrity, and value-based program performance.

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