Risk Adjustment Solution Edifecs

Risk Adjustment
Pre-Visit Prep

Opportunities for effective risk adjustment can arise long before the patient encounter begins. Unfortunately, the density of information in a patient’s chart can make it difficult for providers to cut through the noise and identify where they should focus.

Our SaaS-based Pre-Visit Prep solution leverages AI and NLP to help care teams capitalize on opportunities to close care gaps, deliver more comprehensive care, and maximize value-based care funding.

1 HCC Added for Every ~5 Patients Reviewed

Edifecs helps providers harness the data that matters most. Get in touch to learn more.

Risk Adjustment Solution 1
anticipate
  • Maximize risk capture opportunities with proactive suspecting
  • Flag risk-adjustable opportunities upstream in care delivery
  • Reduce patient history & chart review workloads for CDI specialists

Cut through the noise

Put the most meaningful clinical information front and center.

HCC Risk Adjustment 2
prioritize
  • Focus on patients with large gaps in diagnosis and care
  • Highlight the right clinical information for better care & patient engagement
  • Reduce emergent visits for chronic condition patients

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
monitor
  • Get near-real-time reporting on coder accuracy and productivity
  • Identify early opportunities for provider or coder education
  • Review year-over-year RAF comparison and trend analysis

Track and manage risk adjustment KPIs

Get in-depth insights into your risk adjustment operations with self-service reporting.

News & Insights

Risk Adjustment Overview Data Sheet
A comprehensive risk adjustment strategy: Scalable solutions and services designed to ensure revenue integrity and CMS/State compliance for managed care plans.
Learn More  ❯
Risk Adjustment for Providers Guide
Complete and accurate risk capture is essential to success in value-based contract performance. This guide examines the four points of opportunity where provider organizations can identify and address gaps to achieve greater financial results, ensure regulatory compliance, and enhance care quality.
Learn More  ❯
Natural Language Processing in Healthcare: The Clinical and Financial Opportunity of Suspecting
In part 2 of this two-part eBook series, we examine what suspecting is, the types of suspecting maturity, review clinical suspect examples, and cover best practices for provider suspect deployment before and during a patient encounter.
Learn More  ❯
View All Resources