We care for our clients' business as our business, and think and act like partners. We share our clients' aspirations, and care deeply about their members. Walk through our risk adjustment coding process and learn about how we do it.
Access to real-time project progress with epiConnect
Dedicated Account Managers ensure success of your project
Risk Adjustment & Quality experts working on each coding and chart review project
At the start of the project, your assigned account manager works with you to better understand your needs around reporting, status updates, and project goals. In addition we establish:
We establish the client's preferred output formats to facilitate data exchange
Episource Risk Adjustment Coding Guidelines, which are updated yearly, are discussed in detail
with each new client to clearly identify the standards by which medical records will be coded. These guidelines are based upon CMS/HHS publications and guidance, AHA Coding Clinic, and our experience in risk adjustment coding. We are flexible and accommodate specific requests.
We run a comprehensive data intake and analytics process to ensure the most effective and efficient outreach effort
All data is analyzed to identify issues and errors prior to processing
We run data through our internal database, and normalize it to obtain the most accurate and complete contact information
We prioritize and group data to maximize retrieval rates, and minimize provider abrasion
RETRIEVAL & CODING
As a product of our retrieval analytics, we determine the best chart recovery option that can include a “full service” office visit, as well as a variety of “self-service” mail, fax, and EMR remote options
Our fully-employed team of 1,700 coders (onshore/offshore) can scale quickly and complete projects of any size with the maximum level of accuracy, and following a rigorous quality assurance process.
Our online client portal epiConnect, offers our customers complete transparency into record retrieval and coding projects.
View key project statistics including medical records retrieved, scheduled to be retrieved, being scheduled & Provider Not Participating 'PNP'
Access coding results, and coding issues/mistakes by provider with Provider Scorecard
Once records have been retrieved, view images via "ChartFinder”
Ready-to-view reporting at the provider and member level, as well as customization options
Once the project is completed, we deliver the final output file via the client’s preferred format and method.
At this point, the data can be automatically uploaded to an analytics and Encounter management tool as a continuous cycle that ensures efficiency and data integrity.
Track RAF progress at the member and provider level
Discover additional opportunities for recapture
Stratify members and launch HCC capture campaigns
ENCOUNTER RECONCILIATION & SUBMISSION
RAPS/ EDPS reconciliation
Error prioritization and resolution
RETRIEVAL & CODING
We Create Partnerships
Our retrieval and coding success is fueled by close alignment with our clients’ goals.
Episource serves Medicare, Commercial, and Medicaid plans with a risk adjustment team that cares a lot about getting it done and the relationships we build
One Team Attitude
We partner with our health plan and healthcare clients to emphasize transparency and trust to truly become a valuable extension of their team at every step of the way – from outreach, retrieval, coding to final delivery
With the largest health plans and healthcare organizations as clients, we aim to obtain the best medical chart retrieval rates, the highest coding accuracy and the maximum level of project satisfaction
Track progress of medical chart retrieval, scheduled to be retrieved, on queue for outreach, and charts coded. Obtain detailed reporting at the provider and member level
Providers Not Participating
View reasons for inaccessibility of healthcare providers and steps we are taking for resolution
Once medical charts are retrieved, you can view and download images directly from the tool
BUILT WITH KNOW-HOW
We start by asking the right questions, and then dig deep into the healthcare analytics data to unearth the right solutions
Obtain the Most Accurate Health Plan Member Data
Our approach and strategies are highly customized. We help clients decide where they should focus their efforts and how to obtain the most accurate risk scores
We count with 1,600 certified HCC coders (on-shore/off-shore), account managers, technicians, clinicians, engineers and data scientists – all experienced in leading risk adjustment projects for Medicare, Commercial and Medicaid health plans
Universal American – A WellCare Company l A Healthy Collaboration®
“Our health plans have used Episource for retrospective chart coding for several years and found their ability to meet completion goals regardless of challenging volume to be the best we have experienced. Their customer service team are very professional and transparent throughout the process. I would recommend Episource for retrospective review to anyone.”
Medicare Health Plan
“Episource’s customer service is second to none. The entire organization is very responsive anytime I reach out with a questions. Our plan experienced a significant increase in our HEDIS medical record retrieval rates this year thanks to Episource”