Every risk adjustment gap represents an opportunity: to clarify a member’s health status, to receive complete care funding, and to educate providers on documentation best practices. However, most insurers supporting Medicaid programs cannot address these gaps through retrospective chart reviews or supplemental submissions. Even in cases where retrospective reviews and supplemental submissions are allowed, completing these processes still leads to avoidable delays.
Edifecs Concurrent Risk Adjustment (CRA) helps payers serving Medicaid populations to intervene earlier, close gaps, and ensure chronic conditions are fully and accurately captured before the claims transaction is submitted. Our SaaS-based CRA solution identifies open risk adjustment gaps in near real-time enabling payers to maximize risk adjustment revenue and improve care quality for their members—without disrupting provider partners’ workflows.
Close Up to 8x More Medicaid Gaps
Compliantly attain accurate risk adjustment revenue and get a more comprehensive view of the care your members need.
Flag open risk adjustment gaps in near real-time.
Reduce the administrative burden for your provider partners.
Clearinghouse-agnostic operations allow payers to capture complete payments, faster.
