Risk Adjustment Solutions

Comprehensive Approach to Risk Adjustment

As a health plan decision maker, you want to know if the health conditions reported in the medical records you receive are accurate, current, and complete. With Ciox as your partner, you achieve:

  • Good member/provider connections
  • Efficient medical record retrieval
  • High quality analytics with member-, provider-, and campaign-level drill-downs

Our Risk Adjustment Solution and Services support the needs of:

  • ACA
  • Medicare Advantage
  • Medicaid
  • CMS Direct Contracting

Our full-service Risk Adjustment Analytics system provides:

  • Chart Retrieval & Data Acquisition – Digital & Traditional
  • Risk Adjustment Coding – HCC Coding and Abstraction
  • Second Level Review – NLP Powered with Machine Learning
  • Data Abstraction – Structured & Unstructured
  • Analytics – Pre & Post chase with intuitive reporting
  • Data warehousing
  • Risk score calculation
  • Member targeting
  • Provider selection

Retrospective Risk Adjustment Solutions

The information you need, when you need it, to validate data and close gaps

The most effective retrospective risk adjustment requires a complete understanding of your members and their qualifying health conditions.

Ciox not only expedites access to the clinical data you need through our expansive medical records retrieval network,we deliver both the proprietary technology to assess your data’s accuracy and the coding power to make adjustments, as necessary.

Reflect Each Member’s True Health Conditions for Proper Compensation

Ciox gives health plans the services and support you need for retrospective risk adjustment success:

  • The right data: Using Ciox’s medical record retrieval services, you start the risk adjustment process with the most comprehensive member data available. Digital First approach to retrieval insures faster access to the clinical data you need.
  • The right technology: Our proprietary algorithms and datasets identify members with the greatest probability of having undocumented health conditions and missing diagnoses, so you benefit from access to the greatest number of charts and a complete understanding of your members and their qualifying conditions.
  • Suspect analytics: We can predict the value of coding each of your member subsets to determine probable ROI.
  • Complimentary Outreach: Our outreach solution focuses on identifying the right provider contact to retrieve the records and is offered complimentary with our retrieval project.
  • HCC Coding: Ciox will partner with you and can provide high-quality coding and audit services by CCS-certified experts on or offshore.

Prospective Risk Adjustment Solutions

Improve health and financial outcomes with minimum provider abrasion

Ciox has the AI powered prospective risk adjustment solution you need to drive meaningful provider interactions, confirm pre-existing conditions, enhance HCC coding, and promote improved and appropriate health care for your members.

Provider Relationships Drive Positive Outcomes

Good provider relationships translate to accurate and thorough documentation. Accurate documentation translates to optimum risk adjustment payments.

Ciox maintains insights about 75,000 provider locations, their past records, likelihood to respond, and response timeliness. Using our proprietary algorithms and datasets, ongoing analysis of intervention data, and these provider insights, you have all the information you need to:

  • Identify your high risk members.
  • Confirm which members — or member subsets — may have undocumented health conditions and need reassessment.
  • Select providers for outreach.
  • Realize the optimal record retrieval method.
  • Confirm existing health conditions.
  • Improve documentation with minimum provider abrasion.
  • Ensure high risk members are seen often enough and getting the care and follow-up they need.
  • Reduce future gaps in care.

Advanced Technology Minimizes Administrative Burden

When you work with Ciox, you get analytics and results in dashboards that bring every risk adjustment project into one location. These dashboards are interactive and customizable to assist with data manipulation and analysis. And they are intuitive, easy-to-use and look and feel like a familiar toolset.

Quickly identify conditions not previously identified through claims data to create a suspect list to target within your prospective risk adjustment program.

Contact Ciox to Learn How to Improve Your Risk Adjustment Process

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