This solution helps end multi-vendor management headaches, leverages AI-enabled coding automation with integrated submission compliance and analytics tools, breaks down encounter operations silos, and ensures compliance and risk adjustment accuracy across all managed care lines of business.
Managed care plans of all types struggle with managing the accuracy of risk-adjusted revenue data and with conforming to submission-related encounter guidelines. These issues are compounded by constantly changing regulations, State-specific nuances and the use of multiple submission systems. Overcoming these challenges requires a best-in-class encounter submission platform backed by NLP-enabled operations and analytics. Edifecs delivers the industry’s most complete suite of risk adjustment solutions, by powering managed care plans' success across lines of business.
Streamline Regulatory Compliance
- Enable continuous compliance-monitoring based on changes to the HHS-Developed Risk Adjustment Model Algorithm
- Best-in-class regulatory change management
Improve Risk-Adjusted Revenue Accuracy
- Enable prospective risk adjustment analytics for direct Provider support in clinical settings
- Leverage HCC-prioritized exception workflows, backed by AI/ML technology
- Implement flexible business rules to improve first pass rates
Reduce Audit Exposure
- Deploy a comprehensive solution to streamline MAO-002 and MAO-004 reconciliation
- Enable up-front data validation to prevent the introduction of poor-quality data
Decrease State Penalties
- Utilize dashboards to report and track SLA performance
- Enable mass correction capabilities to fix errors and resubmit data
- Leverage Edifecs-managed module updates based on State-specific changes