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Risk adjustment analytics

Our advanced risk adjustment analytics and suspecting solution identifies areas of opportunity, assesses program performance, and measures impacts over time.

“We provide outcomes and metrics that basically show you the health of a health plan.”

Vijaya Vishwanathan, Episource Director of Product

Episource Analyst

Our advanced risk adjustment analytics strategy and deep subject-matter expertise make it easy to assess program performance, identify and act on areas of opportunity, and measure the impact of your efforts over time.

Our advanced risk adjustment analytics strategy and deep subject-matter expertise make it easy to assess program performance, identify and act on areas of opportunity, and measure the impact of your efforts over time.

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Episource Analyst is a comprehensive, risk adjustment analytics workflow platform that turns data into actionable insights at the touch of a button.

Rich Analysis at Your Fingertips

  • Complete visibility for earlier intervention
  • Program assessment driving actions
  • Ranked chase lists
  • Campaigns for measurable impact
  • Innovations for all audiences, including Medicare Advantage, Medicaid, and ACA health plans
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Recover Lost Opportunities

“After conducting an incremental codes-to-claim analysis, Episource found a lost revenue opportunity of ~$428 per member per month.”

– Health Catalyst

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Unparalleled Results

Episource Analyst helped one regionally managed care organization achieve a 30% RAF increase within just two years of implementation.

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Risk Adjustment Program Assessment

Delivers a comprehensive analysis that highlights how your risk adjustment program has performed historically and where there are opportunities to increase impact.

Delivers a comprehensive analysis that highlights how your risk adjustment program has performed historically and where there are opportunities to increase impact.

Risk Adjustment Program Assessment

Leverage our advanced risk adjustment analytics strategy and deep subject matter expertise to assess your risk program performance. We will help you identify areas of opportunity, work with you to implement recommended interventions, and measure the impact of your efforts over time.

Data-Driven Insights

Our experts deliver a comprehensive analysis that highlights how your risk adjustment program has performed historically and where there are opportunities to increase impact.

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Set Program Strategy

We provide strategies and recommendations that impact the most critical elements of patient care and program performance enabling you to make real-time decisions that drive outcomes.

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Seamlessly Execute Interventions

Our people and platform significantly reduce the administrative burden required to manage and analyze data, implement strategic programs, and continuously measure success.

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Compliance Review

Generated by Episource Analyst, this comprehensive report identifies claims and conditions that are at high risk of regulatory audit.

Generated by Episource Analyst, this comprehensive report identifies claims and conditions that are at high risk of regulatory audit.

Compliance Review

Generated by Episource Analyst, this comprehensive report identifies claims and conditions that are at high risk of regulatory audit.

Audit Prevention

Avoid an audit from CMS or OIG by identifying the practices that commonly trigger audits and flagging HCCs at high risk of an audit.

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Complete Transparency

Compliance Review provides visibility and transparency into the specific HCC codes that flag an audit. We provide a segmented breakdown of members across four key categories of risk.

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Seamless Integration

Our Compliance Review service is seamlessly integrated within Episource Analyst — a one-stop shop for compliance needs. Utilize both to close gaps, solve for RAF score, and be RADV- and CMS-compliant.

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Retrospective Compliance Cleanup

Our one-time consultative engagement service surfaces and resolves compliance risk in the months before final submission deadlines.

Our one-time consultative engagement service surfaces and resolves compliance risk in the months before final submission deadlines.

Retrospective Compliance Cleanup

Our one-time consultative engagement service surfaces and resolves compliance risk in the months before final submission deadlines.

Match OIG Analytics With Your Own

We aggregate encounter data for a given performance year and deploy proprietary algorithms and natural language processing (NLP) flagging to isolate specific fact patterns among diagnosis codes, surfacing those likely to fall short of compliance with ICD-10 requirements.

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Surface High-Risk Diagnosis Codes

Our compliance and analytics experts ingest your organizations data and surface 10+ categories of high-risk codes and audits these for ICD-10 compliance. These categories include:

  • Nine categories of OIG’s Selected High-Risk Diagnosis Codes
  • Diagnoses from HRAs that are inappropriate for telehealth
  • Diagnoses from non-risk adjustable telehealth visits
  • Diagnoses documented by one provider or by one coder
  • Additionally surfaces net-new codes
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A Roadmap for Remediating Risk

Once we identify the non-compliant codes, our experts provide your organization with a comprehensive spreadsheet that lists each issue code, the reason we flagged it, and the relevant encounter information.

From there, our experts work with you to provide an action plan for resolution, which can include NLP-enhanced audit, additional retrieval, and deletes for non-compliant codes.

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Deep Analysis

Expert Analytics