Get a 360 Degree View Of Your Risk Adjustment Program

Leverage Episource’s advanced risk adjustment analytics technology and deep subject matter expertise.

About the Service

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.

Features

RAF Reporting

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.

HCC Analysis

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.

 

Actionable Task Lists

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.

 

Full Consulting Support

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.

 

End-to-End Execution

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.

 

How It Works

Gain visibility into your plan’s performance

Execute data-driven interventions

Make real-time decisions

Close member gaps

Improve program performance

Our Impact

0 %

YOY increase in risk score for Medicaid clients

0 %

YOY increase in risk score opportunity for Medicaid clients

$ 0

PMPM identified in average revenue opportunity across multiple health plan clients

Testimonials

Episource Client

I am impressed by the level of preparation and comprehensive analysis; it is far beyond what we are used to receiving from a vendor.

Episource Client

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.

Episource Client
They’ve added in features where we can actually see the campaigns in real time and watch it progress through the dashboards and get all kinds of great reporting.

Additional Resources