New Resource: HCC Tearsheet 2025. Access Now!
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New Resource: HCC Tearsheet 2025. Access Now!
Health plans often lack visibility into the errors that exist within their encounter data, leading to incomplete submissions and lost revenue.
To help solve this issue, we created Episource Submitter, a cloud-based SaaS encounter data management and risk adjustment encounter submissions platform that works for every model within the Medicaid, Affordable Care Act, and Medicare Advantage markets.
With our solution, health plans can identify and fix encounter data errors, reconcile RAPS/EDS files, and estimate accurate financial projections.
Our analytics team will create a comprehensive report on year-over-year risk adjustment factor (RAF) trends, as well as how your organization’s RAF score performs against CMS benchmarks. In addition, we not only identify areas of RAF opportunity, but also estimate their potential value.
We provide insights into how your HCC recapture rates are trending over time, as well as factors that are impacting these rates. We also identify the historical and current percentages of members in your program with no HCCs.
We identify high-risk members who need immediate care, as well as unengaged patients that require outreach. We also provide you with a list of providers that have a higher or lower than average patient engagement rate, and those that have a higher or lower than average percentage of high-risk members.
With Risk Adjustment Program Assessment, you’ll be partnered with a dedicated project team, as well as a group of data strategists, product directors, and analysts.
Beyond just delivering risk adjustment analytics, we have the ability to carry out many of the recommendations we make, from retrieval to coding, and more.
Gain visibility into your plan’s performance
Execute data-driven interventions
Make real-time decisions
Close member gaps
Improve program performance
YOY increase in risk score for Medicaid clients
YOY increase in risk score opportunity for Medicaid clients
PMPM identified in average revenue opportunity across multiple health plan clients
I am impressed by the level of preparation and comprehensive analysis; it is far beyond what we are used to receiving from a vendor.
The presentation inspired us to begin using the data points to prepare for our key Internal Risk Adjustment Workgroup with upper management and grade ourselves on how we can improve our processes.
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