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Proven industry expertise to maintain compliance and
deliver transparent payment and reconciliation results.
Click to learn more about our solutions, or to view white papers, case studies and more.
Our customers gain a complete end-to-end solution for all payment and reconciliation facets of Medicare. Our solutions are built around the CMS calendar and leverage the intimate experience of our professional staff. We have experience working with federal and state regulations and transforming them into solid business practices thanks to our narrow focus, open communication and transparent solutions.
In recent years, many payers have turned to their government business to be a driver of membership and revenue growth. This in turn puts an even greater premium on compliance and revenue optimization.
Revenue is estimated to decrease by 12% for all MA plans by 2017.
Healthcare reform will bring about new rules and regulation in an ever changing environment.
Explore our solutions that include audits of outside or other previously used coding services.
A full review of all member encounter data and CMS risk adjustment submissions to identify each variance.
Analyze and predict risk for Commercial, Medicare, and Medicaid populations with this comprehensive collection of...
A highly flexible, web-based platform that combines powerful online analytics with the ability to support diverse...
Reduce your facility claims with our expertise in editing and negotiation.
Prospectively identify new and emerging fraud schemes with next generation technology and clinical review.
Apply clinical and predictive modeling with clinical validation to increase accuracy and minimize false positives.
Generate NCQA certified HEDIS rates, drill to member detail, perform chart review and generate IDSS submission.
Identify and stratify populations at the group or individual levels with this highly scalable, easy to use,...
Retrieve records, capture additional revenue while maintaining strict compliance through our certified clinicians.
Deliver superior payment recommendations by combining sub-second processing with transparent, open-source edits.
Ensure health plans are paid appropriately for every enrolled member with our financial reconciliation system.
Identify and close gaps in quality and care while reducing expenses and improving risk score accuracy.
Reveal opportunities for optimizing clinical value, improving the quality of care and reducing medical costs.
RAPS files are prepared using our proprietary logic and our EDS solution maintains proper revenue recognition.
View detailed daily, weekly and monthly reporting on all aspects of our risk adjustment programs.
Implement recommendations, track outcomes and improve your Star ratings through detailed insight.
