Prospective Risk Adjustment solution
Accurately document disease burden and close care gaps
Fill form to unlock content
Error - something went wrong!
Please complete this brief form to view this item.
Without insights into the disease burden of their members, health plans cannot intervene and coordinate adequate care, and untreated conditions can lead to increased reliance on avoidable high-cost care like emergency room visits and inpatient stays. Additionally, deferred healthcare utilization and a coinciding drop in claims could lower risk-related payments.
Cotiviti’s Prospective Risk Adjustment solution address these challenges by helping health plans gain insights into their member’s risk profile, accurately document disease burden to secure risk-related reimbursement, close gaps in case, and enable proactive interventions.
- Add incremental value of $1,400 on average per member annually
- Ensure appropriate risk-adjusted payments with accurate documentation and coding of member conditions
- Achieve ROI of 4–7x based on increased risk adjustment factor (RAF) from conditions that map to new or higher-revenue HCCs