Improve Your Health Plan’s Risk
Adjustment Performance

Leverage Innovaccer’s solution suite for payers to meet your risk adjustment needs. Identify coding gaps based on clinical and claims data-driven analytics, covering both drop and suspect codes. Enable providers to prospectively improve coding accuracy by providing them actionable gap insights at the point of care, and unlocked improved retrospective review outcomes with NLP-facilitated coder chart review workflows.

Close Coding Gaps For Your Health Plan Members

Identify drop or
suspect codes

Present open coding
gaps to clinicians at
the point of care

Leverage digital chart
retrieval for clinical
data access

Drive retrospective
review via coder chart
review workflows

Track risk adjustment
performance over
time

Identify drop or suspect codes

Analyze historical claims data and clinical documentation to identify drop codes and suspect codes. Run risk adjustment analytics to identify diagnosis codes and/or HCC codes supporting both prospective and retrospective review outcomes.

Aggregate claims and clinical data on members
Run analytics for drop codes (e.g., chronic disease diagnosis captured last year)
Run analytics for suspect codes based on clinical data (e.g., suspected diabetes based on lab results and medications)
Drive prospective and retrospective review workflows with open coding gaps inputs

Present open coding gaps to
clinicians at the point of care

During outpatient visits, present open coding gaps on
an EMR overlay interface. Drive prospective review
gaps closure right at the point of care.

Present open coding gaps at the point of care, covering relevant diagnosis and/or HCC codes
Provide details on supporting evidence, including underlying data sources
Enable provider-inputted gap responses
Directly integrate with EMRs to push accepted coding changes seamlessly into clinic notes

Leverage digital chart retrieval
for clinical data access

Connect directly with EMR systems for automated clinical data access on your members. Bring in structured clinical data and clinical documentation for downstream risk adjustment needs.

Utilize pre-built connectors to directly integrate with priority EMR systems
Capture relevant historical clinical data, and bring in ongoing updates on your members
Improve provider satisfaction with a seamless solution for clinical data access

Drive retrospective review via
coder chart review workflows

Closing coding gaps retrospectively with natural language processing (NLP)-facilitated coder chart review workflows.

Help coders maintain a worklist of prioritized tasks
Flag open coding gaps to coders, covering relevant diagnosis and/or HCC codes
Provide an encounter-based view of clinical documentation by member
Utilize NLP to automatically identify potential coding gaps and/or supporting evidence
Support reviewing of coder guidelines and resources to facilitate review efforts

Track risk adjustment
performance over time

Drive performance through highly customized dashboards that provide insights on operational and outcome metrics of interest.

View aggregate dashboards with views on risk adjustment performance over time
Drill-down into areas of lower performance across a range of parameters (e.g., HCC codes, providers)
Track operational metrics on efficiency of prospective and retrospective review efforts