Software

Dx Gap Advisor™

An analytics-driven risk adjustment review solution for payers that want a unique, compliant process to support diagnosis coding accuracy, streamline billing workflow, and close risk gaps.

 

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Close Risk Gapswith Accurate Coding

  • Increase compliance and efficiency by helping to ensure the accuracy, completeness, and truthfulness of risk adjustment data.

  • Accelerate Medicare Advantage risk-adjusted payments through concurrent capture of missing chronic diagnosis codes. Avoid the long reimbursement delays typically associated with retrospective chart review.

  • Help increase transparency and reporting clarity with a data-driven audit trail of Dx Gap Advisor transactions.
  • Help reduce provider abrasion through collaborative approach to changing coding habits and behavior. Provider self-auditing and coding validation helps capture diagnosis gaps.

  • Create new revenue opportunity in Medicaid states that do not allow diagnosis code encounter edits from medical record reviews.

  • Streamline provider workflow and improve collaboration by providing a tool that works within the billing workflow to support complete, accurate diagnosis coding before claims are submitted.

Transform Your Risk Adjustment Strategy

  • Identify Risk Gaps in Real Time

    • Utilize our Risk View™ analytics scoring engine to identify claims that do not include a patient's previously diagnosed chronic conditions.
    • Deliver real-time or next day claims status messages. Dx Gap Advisor sends these messages through the Intelligent Healthcare Network™ to the individual or entity that submitted the claim.
    • Optimize diagnosis reporting and support increased quality of care by reviewing the most frequent chronic diagnoses codes located in the patient's claims history.

  • Align Pre-Submission Claims Validation with Provider Workflow

    • Engage providers within their existing billing workflow to help ensure complete and accurate documentation prior to the adjudication of claims.
    • Help reduce the burden on providers to support multiple health plan initiatives by promoting medical record review at the point of billing, close to the medical encounter, which is often most efficacious.
    • Leverage technologically advanced tools to help providers embrace proactive education. Providers can easily adopt new processes and change existing behaviors using tools incorporated into their existing billing workflow.

  • Expedite and Optimize Payments

    • Help reduce disruptive, costly, and labor-intensive in- office medical record review and requests for medical records.
    • Counteract traditional retrospective medical record reviews that often delay payments and are prohibited by some states.
    • Expedite risk-adjusted payments by electronically identifying risk gaps earlier within the claims billing cycle.

Our outcomes

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Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Learn how an AI-driven review of a health plan’s Medicare Advantage claims produced an annualized gain of $357,000

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Video

Optimizing Risk Analytics with a Data Integration Cloud

Video

Optimizing Risk Analytics with a Data Integration Cloud

Learn how our Integrated Delivery Platform aggregates data from disparate systems to: Optimize risk analytics, Ease compliance with CMS mandates, and more.

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On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

Watch this AHIP webinar to discover best practices for integrating risk, quality, and value-based care to improve outcomes and manage costs for Medicaid enrollees.

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