SecqureOne’s Risk Adjustment Solutions offer Health Plans integrated end-to-end services to significantly improve their risk-adjusted revenues. 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.

As CMS expectations regarding risk adjustment continue to evolve, health plan, ACOs, and capitated health systems must design and flawlessly implement a strategic, mixed model that incorporates a meaningful percentage of retrospective, concurrent, and prospective initiatives, plus drives data integration with care management. Whether you rely on multiple vendors or a largely internal team, SecqureOne can help you streamline the execution of your risk adjustment approach, and build a roadmap to ensure you’re keeping pace with CMS expectations in both compliance and health care outcomes.

Key Services

  • Claims Data Validation
  • Report based on inferred/deduced diagnosis
  • Certified coders (CPC) perform in-depth chart reviews
  • Part C (HCC) Coding – RADV-focused yearly capture or encounter-based

Benefits:

  • Trained and Certified coders for chart review
  • Ensuring accurate, compliant coding practices
  • Ensure effective CMS compliance in terms of codes
  • Minimize Errors and Maximize Accuracy (95% guaranteed)
  • Coders are assigned supervisor to ensure quality output

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