Indegene Healthcare
485B Route 1 South Suite 300
Iselin
New Jersey 08830
Phone: +1 732 750 2901
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Improve Risk Score Accuracy to Enhance Revenues and Support Accurate EDPS/RAPS and EDGE Server Submissions

Improve Risk Score Accuracy to Enhance Revenues

Indegene Healthcare enables health plans to maximize their risk-adjusted revenues and improve risk score accuracy by accurately identifying coding and documentation gaps and facilitating effective gap closures with a suite of end-to-end risk adjustment solutions.

Leverage Natural Language Processing (NLP) capability and EMR integration services with innovative provider education and engagement methodologies and proprietary clinical and whitespace analytics to identify potential risk-score improvement factors and improve care gap closure rates.

Streamline and support accurate RAPS/EDPS and EDGE Server submissions.

Medicare, Medicaid, and HIX Risk Adjustment Outcomes
Medicare, Medicaid, and HIX Risk Adjustment Outcomes
How It Works

Indegene's Risk-Adjustment solutions offer health plans integrated end-to-end services to significantly improve their risk-adjusted revenues by identifying uncoded, undercoded, and miscoded opportunities and documentation gaps. We support health plans by prospectively identifying potential high ROI members and providers and strategize their risk-adjustment programs to effectively improve health plan performance. With end-to-end data-driven insights powered by advanced predictive analytics, targeted medical record data validation, quality control, and reporting with drill-down capabilities, we help health plans improve the accuracy of their risk scores and maximize their financial outcomes.

Integrated Risk Adjustment workflow
Solutions
Experience Precision and Accuracy in Your Risk-Adjustment Strategies

Our advanced informatics and predictive modeling enable health plans devise intelligent population- and individual-level risk-adjustment strategies. Robust medical algorithms and evidence-based guidelines with valid rule sets enable health plans to accurately identify risk score improvement opportunities using Hierarchical Condition Categories (HCCs), identify Risk-Adjustment Factor (RAF) gaps, and quantify RAF improvement opportunities. Our prospective suspect analysis helps identify members with suspect and undocumented conditions. Based on the potential clinical and financial impact, we perform assessments and scoring by identifying and prioritizing members with the highest probability of having missing or incomplete diagnosis codes.

Accurate and Cost-effective HCC Coding

Indegene's Medical Coding with hybrid deployment assures health plans of secure, accurate, and on-time coding of patient diagnosis. With the implementation of ICD-10 codes in the industry, mapping of patient diagnosis and capturing accurate information ought to become extensive and complex. Our AAPC, CPC, and AHIMA-certified coders accurately capture missing risk-adjusted diagnoses, minimize errors, and ensure certainty in members being appropriately risk-adjusted and qualified for the risk-adjusted premium. Our coding solutions assure that diagnoses are captured accurately and supported within the medical records, handle the most complicated coding assignments with utmost specificity, and thus facilitate a smoother CMS/HHS submission.

Request Records and Retrieve Charts on Demand

Indegene's streamlined Medical Record Retrieval (MRR) solutions comprise proven chart retrieval and review services present both onsite and offshore, with remote access to EMR systems to ensure faster turnaround times and better adherence to compliance. Our solutions can efficiently scale for high-volume requests through multiple sources such as live feeds, electronic files, and other prominent data sources that can be seamlessly handled and managed by the provider staff with unmatched accuracy, speed, and cost-efficiency.

Engage. Empower. Enlighten.

Indegene's Physician and Staff Education Solutions empower physicians and staff with education and training programs to fully equip them with contemporary industrial best practices throughout the risk-adjustment life cycle, thus striving for 100% compliance. Right from end-to-end risk-adjustment training and performance analysis of the participants to providing member-level actionable gaps and educating with coding and documentation best practices, our solutions can significantly broaden the scope and acumen of physicians and staff involved in all phases of risk adjustment.

Hygiene Checks and Validations for Smooth Auditing

Indegene's expertise in Risk-Adjustment Data Validation (RADV) audit provides customized full audit support in validation and documentation of enrollment, claims, medical records, and supplemental data, ensuring hassle-free audits and increased compliance. With a fully trained and expert RADV quality team to support Health Plan's RADV requirements, Indegene empowers Health Plans to target the most acceptable medical records for sampling, right from data import and record retrieval through review, code charts, and data submissions.

Easy and Error-Free Encounter Data Submission

Indegene provides health plans with automated, streamlined, accurate, and time-bound data submission services with CMS compliance. Our services equip payers with a flexible and comprehensive approach to conform to CMS regulations to achieve complete and accurate data submissions. Our data submission platform supports EDPS, RAPS, and Edge Server formats, as defined by CMS for Medicare and Commercial plans enabling Health Plan staff to effortlessly create workflows to handle exceptions; continuously monitor the data submission error rates, perform root-cause analysis, and drive resolutions.

  • Risk Analytics
    Experience Precision and Accuracy in Your Risk-Adjustment Strategies

    Our advanced informatics and predictive modeling enable health plans devise intelligent population- and individual-level risk-adjustment strategies. Robust medical algorithms and evidence-based guidelines with valid rule sets enable health plans to accurately identify risk score improvement opportunities using Hierarchical Condition Categories (HCCs), identify Risk-Adjustment Factor (RAF) gaps, and quantify RAF improvement opportunities. Our prospective suspect analysis helps identify members with suspect and undocumented conditions. Based on the potential clinical and financial impact, we perform assessments and scoring by identifying and prioritizing members with the highest probability of having missing or incomplete diagnosis codes.

  • Medical Coding
    Accurate and Cost-effective HCC Coding

    Indegene's Medical Coding with hybrid deployment assures health plans of secure, accurate, and on-time coding of patient diagnosis. With the implementation of ICD-10 codes in the industry, mapping of patient diagnosis and capturing accurate information ought to become extensive and complex. Our AAPC, CPC, and AHIMA-certified coders accurately capture missing risk-adjusted diagnoses, minimize errors, and ensure certainty in members being appropriately risk-adjusted and qualified for the risk-adjusted premium. Our coding solutions assure that diagnoses are captured accurately and supported within the medical records, handle the most complicated coding assignments with utmost specificity, and thus facilitate a smoother CMS/HHS submission.

  • Medical Record Retrieval
    Request Records and Retrieve Charts on Demand

    Indegene's streamlined Medical Record Retrieval (MRR) solutions comprise proven chart retrieval and review services present both onsite and offshore, with remote access to EMR systems to ensure faster turnaround times and better adherence to compliance. Our solutions can efficiently scale for high-volume requests through multiple sources such as live feeds, electronic files, and other prominent data sources that can be seamlessly handled and managed by the provider staff with unmatched accuracy, speed, and cost-efficiency.

  • Physician and Staff Education
    Engage. Empower. Enlighten.

    Indegene's Physician and Staff Education Solutions empower physicians and staff with education and training programs to fully equip them with contemporary industrial best practices throughout the risk-adjustment life cycle, thus striving for 100% compliance. Right from end-to-end risk-adjustment training and performance analysis of the participants to providing member-level actionable gaps and educating with coding and documentation best practices, our solutions can significantly broaden the scope and acumen of physicians and staff involved in all phases of risk adjustment.

  • Audit and RADV Support
    Hygiene Checks and Validations for Smooth Auditing

    Indegene's expertise in Risk-Adjustment Data Validation (RADV) audit provides customized full audit support in validation and documentation of enrollment, claims, medical records, and supplemental data, ensuring hassle-free audits and increased compliance. With a fully trained and expert RADV quality team to support Health Plan's RADV requirements, Indegene empowers Health Plans to target the most acceptable medical records for sampling, right from data import and record retrieval through review, code charts, and data submissions.

  • Data Submission
    Easy and Error-Free Encounter Data Submission

    Indegene provides health plans with automated, streamlined, accurate, and time-bound data submission services with CMS compliance. Our services equip payers with a flexible and comprehensive approach to conform to CMS regulations to achieve complete and accurate data submissions. Our data submission platform supports EDPS, RAPS, and Edge Server formats, as defined by CMS for Medicare and Commercial plans enabling Health Plan staff to effortlessly create workflows to handle exceptions; continuously monitor the data submission error rates, perform root-cause analysis, and drive resolutions.

Benefits
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Improved risk-adjusted revenue by uncovering coding and documentation gaps

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100% CMS compliance in risk-adjustment strategies

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Accurate financial performance tracking and reporting to effectively manage ROI

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Broad member outreach and engagement across provider network

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Accurate Medical Record Retrieval (MRR) and chart review with least disruption for provider staff

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Effective and compliant RADV support with complete understanding of variables and timelines

Related Resources
resources
Corporate News

Indegene and TranScrip launch IntraScience – an innovative regulatory, safety, and medical services solution for global biopharmaceutical companies arrow_forward

May 25, 2016

Indegene expands omnichannel software and commercial solutions portfolio through acquisition of Skura Corporation's life science business arrow_forward

Apr 29, 2016

Events and Conferences

Amga 2017 annual conference, Gaylord Texan Resort & Convention Center, Grapevine, TX arrow_forward

Mar 22-25, 2017

Seventeenth Population Health Colloquium, Loews Philadelphia Hotel Philadelphia, PA arrow_forward

Mar 27-29, 2017