Commercial Risk Adjustment

identify risk to ensure appropriate funding

Verscend's Commercial Risk Adjustment solution calls upon decades of experience in Medicare Advantage risk adjustment to equip Qualified Health Plans with an integrated set of tools to succeed in this revenue-critical risk adjustment environment. From suspect targeting and record retrieval to detailed coding, risk score calculation, and EDGE server hosting and data submission, our data and analytics offer an accurate view of your plan's population. This approach ensures that you are appropriately funded to manage your plan members and the full scope of their conditions.

"With the Affordable Care Act's temporary risk corridors and reinsurance coming to an end, risk adjustment is the primary tool that Community Health Choice has to support fair competition in the Texas health insurance marketplace. But successful risk adjustment is not easy. We need to get the right data into EDGE, reconcile what comes back, understand what to look for in medical records, and so on—all on a tightly prescribed timeline. We selected Verscend as our partner in 2014, and their risk adjustment experts work alongside us every step of the way, coaching us and helping us through related issues that arise."

-- Amy Gray, Director of Finance, Community Health Choice


Suspect Analytics

Our proprietary model helps identify members with suspect conditions and possibly undocumented conditions appropriate for prospective and retrospective targeting. This model individually considers HCCs and other factors that may indicate treatment of an unreported condition.

Medical Record Retrieval

Our web-based medical record retrieval and imaging solution allows retrieval staff to group, prioritize, and initiate medical record requests with the least possible amount of disruption to providers and their office staff.

Medical Record Coding

The success of a risk-adjusted program is often determined by the identification of undocumented HCCs within targeted medical records. Verscend is able to securely deliver medical records to our best-in-class certified clinician coders who have an in-depth understanding of risk adjustment coding environments and specific CMS rules and guidelines.

Edge Server Hosting and
Data Submission

Verscend provides a full-service offering of secure EDGE server hosting, file submission workflow and reporting to alleviate the time, resources and stress from aligning data files with CMS edits and reconciling data submission errors.

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