ie-message
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    Avoid errors by proactively engaging and educating physicians

  • img

    Prevent reoccurrence of gaps

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    Improve risk score accuracy and health outcomes

    Download Brochure
  • img

    Avoid errors by proactively engaging and educating physicians

    img
  • img

    Prevent reoccurrence of gaps

    img
  • img

    Improve risk score accuracy and health outcomes

    Download Brochure img
Challenges

< 35 %

Overall suspect validation rates

~ 30 %

Limited gap closure rates

< 25 %

Reduced ROI compared with benchmarks

iRisk- Indegene Risk Adjustment Solution

Providing the most efficient approach to optimize revenues

Indegene iRisk seamlessly integrates claims data, clinical data, pharmacy data, lab data, non-clinical data such as behavioral data, psychographic data to create meaningful visualizations and apply statistical and clinical analytics for actionable insights. The data is processed at three levels, coder, provider and member to improve the risk accuracy and predict right providers and members for interventions with real-time integration.

Our industry best innovative approach uses tools, capabilities, and services that cut across Analytics, Technology, and Operations and is built on years of Medical expertise.

With proactive risk planning, documentation, and provider engagement, driven by industry-leading technology capabilities, iRisk improves risk-adjusted revenues for Medicare, Medicaid, and Commercial markets significantly.

Solution Approach

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Develop a 360° view of the patient through EMR integration

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Proactively identify gap by looking for prospective member targets and setup encounters early in the year and avoiding retrospective gaps from occurring

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Reduce documentation errors by driving physician education and clinical reviews, ensuring risk score accuracy

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Improve coding accuracy using insights from NLP capabilities

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Achieve significant reliability in suspect analytics by leveraging on our extensive clinical knowledge while incorporating machine learning with the highest confidence levels

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Engage members effectively through omnichannel, provider-driven outreach to ensure higher receptiveness

Features and Benefits

Features

Benefits

Commercial

  • Advanced Clinical Analytics to identify Suspect HCCs

  • Enhanced chart retrieval Analytics based on Provider specialty

  • Value based member segmentation for Prospective risk adjustment

  • High accuracy in suspecting members based on Clinical algorithms

  • Accurate in targeting the right provider for Chart retrieval.

  • Deployment of prospective RA efforts based on the value preposition helps in higher returns with lower cost.

Medicare

  • Strong ability to identify dropped HCC's

  • Platform driven Engagement Analytics

  • Customizing and optimizing educational content for providers and their staffs.

  • Clinically driven analytics in identifying Chronic and Recurrent HCCs which are undocumented in current year.

  • Helps addressing the dropped HCCs by technology driven provider engagement through iCE.

  • Help Physician organizations, providers, and office staff to improve accuracy in documentation and Coding.

Medicaid

  • Advanced Clinical Analytics in identifying Under-coded and Uncoded opportunities

  • Integrated Reporting Platform

  • Integrated Delivery System using CodeMax

  • Accuracy in identifying un-coded and under-coded conditions with potential Risk Adjustment Factors (RAF) improvements.

  • A single dashboard to view all RA related activities like RAF scores, Prospective RA efforts, Retrospective RA efforts, Retrieved Charts and Coded diagnosis.

  • With EMR and NLP technology used in Codemax, there is substantial reduction in hours consumed for coding and have maintained a higher accuracy.