Our popular chart review workflow and medical chart coding and reporting solution uses our proprietary database with weighted diagnosis codes and NCD codes to map health conditions and identify coding errors. Users can monitor progress of chart retrieval and coding results, perform initial or first pass coding, perform or monitor quality assurance, access charts for member care and case management, review CMS history and health plan records for members, and review suspect conditions for each member.
Our EDSQ solution responds to the new CMS data and modifications in data formatting so our clients don't have to. Through automated tools and processes, plans can create and submit fully attributed HIPAA X12 5010 837 I, P claims transactions for all encounter types. Plans may receive and process CMS responses to claims transactions, manage front-end automated data quality systems and automate the handling of CMS-related data exceptions.
Coupled with programs and consulting, plans can improve star rating measures with our web-based StarNavigator application. It provides detailed analysis and through proprietary logic, users get recommendations about measures that can quickly and effectively be improved. StarNavigator tracks progress, generates member lists for specific improvement and provides powerful reporting features along with a calculator to see the impact of rating changes on all levels.
Whether it's minimizing risk score or improving compliance, ReconEdge is our proprietary web-based plan membership and financial reconciliation system designed specifically for financial reconciliation, forecasting and reporting. ReconEdge incorporates the best business practices and powers them with robust technology allowing Verisk Health to assess and recommend strategies for reaching your plan's performance objectives.