Converged Risk

Converged Risk is a comprehensive risk score accuracy software designed to support health plans in managing their risk adjustment programs effectively. It helps mitigate audit risks and ensures accurate reimbursement by identifying and correcting over-coded conditions. This software is powered by the Inovalon ONE® Platform, offering scalability and customization to meet the unique needs of different programs.

The software provides complete visibility into the risk adjustment process, allowing health plans to uncover hidden gaps and ensure full reimbursement for members' risk burdens. It also focuses on improving care for members with chronic conditions, thereby enhancing health outcomes and plan performance.

Key Benefits

• Utilizes machine learning analytics to detect coding errors and clarify member diagnoses.
• Improves reporting and documentation through HCC surveillance analytics.
• Facilitates data-driven intervention planning and execution with proven strategies.
• Offers predictive analytics insights for gap identification and intervention planning.
• Ensures compliant and accurate regulatory submissions by managing claims processing effectively.

Converged Risk empowers health plans to control their risk adjustment programs, reducing audit risks and ensuring accurate reflection of the population's risk burden. It supports better member care and improved health outcomes, making it an essential tool for health plans facing regulatory pressures.