Press Releases

Episource Announces Expansion of Risk Adjustment Tools to Medicaid and ACA Plans

Premier full-service risk adjustment and quality vendor delivers cutting-edge tools to help Medicare, Medicaid, and ACA plans unlock significant revenue savings opportunities


Los Angeles, Calif., September 24, 2020  Episource, a pioneer in risk adjustment and quality solutions for healthcare payer and provider organizations, today announced it is expanding two of its risk adjustment SaaS tools into Medicaid and ACA health plans: epiAnalyst, its risk adjustment analytics and workflow platform, and epiEncounter, its encounter submissions, error management, and financial analytics platform. With this expansion, Medicaid and ACA organizations will now have the opportunity to share in significant revenue savings opportunities.

With unemployment rates hovering around eight percent, millions of Americans are becoming eligible for Medicaid and other marketplace subsidies. As Medicaid enrollment continues to rise above projections, so too will spending. According to a recent study from the Kaiser Family Foundation, 40% of states surveyed expect to see deficits in 2020—and nearly all anticipate budgeting shortfalls in 2021. Now, more than ever before, it has become critical for Medicaid programs to find ways to unlock revenue savings. To this end, Episource has expanded its suite of risk adjustment tools to help Medicaid and ACA plans survive the pandemic.

“We are very pleased to expand our risk adjustment offering to Medicaid and ACA plans at a time when they need it most. Our mission at Episource has always been to simplify healthcare—and making our tools and platforms available across a wider range of organizations is a direct reflection of this goal,” said Shishir Reddy, Episource Co-CEO.

With its clean, intuitive interface and flexible, streamlined dashboards, epiEncounter has been helping Medicare Advantage organizations maximize the reconciliation process since 2016, recouping millions of dollars in potential lost revenue from the RAPS-EDS recon/data exercise while significantly reducing MAO-002 rejection rates. The Encounter data error resolution and financial planning tool will now be available to Medicaid and ACA plans to track submissions and responses with the same accuracy and ease.

In addition to epiEncounter, Episource’s cloud-based risk adjustment platform, epiAnalyst, has also delivered significant value to health plans since its launch in 2015. In this time, epiAnalyst has significantly improved average RAF lift per member and helped close a large number of HCC gaps for Medicare plans across the country.

“epiEncounter and epiAnalyst are more than just risk adjustment tools—they are a team of Episource experts on your side ready to help you from the implementation and ingestion process through everyday support and training, leaving your team with fewer demands for their time,” said Harshith Ramesh, Episource Co-CEO.

Both applications are part of Episource’s full suite of products, which also includes: epiConnect, a client portal and reporting platform, epiVault, a chart storage and management platform, and epiVirtualCare, a telehealth platform.



About Episource
Episource reinvents risk adjustment program management across healthcare organizations with an integrated platform. We empower the most recognizable names in healthcare with end-to-end risk adjustment solutions. From risk adjustment analytics, retrospective chart reviews, in-home assessments, encounter submissions and quality reporting, Episource simplifies healthcare with elegance and innovation.


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider