The Problem: Remaining Compliant

Without accurate payment, enrollment and PDE files, plans are missing vital processes in the HCC lifecycle. Recently, an audit of risk scores and payment estimates validated our calculations at 100% accuracy. As a result, our clients improved revenue by up to 18% through enhanced accuracy data reconciliation and submission.

The Solution: Premium Reconciliation

Features

  • Identify and track member enrollment and payment discrepancies
  • Discrepancies are updated as they are worked and resolved by your plan
  • Reporting for monthly CMS attestations
  • View all CMS history on individual members
  • View all CMS data provided to Verisk Health

Benefits

  • Highly accurate, member-level receivable estimates for the payment year final reconciliation, the mid-year update, and the Part D final reconciliation, for all risk adjustment factor types
  • Track and work rejected PDE records, resubmit to CMS for acceptance
  • Compare the imported CMS MMR to the plan data eligibility file to identify discrepancies between the two

Next Steps

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