Risk Adjustment

The Risk Adjustment Software, powered by the Inovalon ONE® Platform, is designed to enhance the accuracy of risk scores and streamline regulatory submissions. It helps professionals close diagnosis gaps and prioritize member needs, offering a clearer view of data through real-time analytics. This ensures complete transparency across initiatives, facilitating faster and more accurate identification of risk gaps.

Key features include:

• Converged Risk: Provides complete control over risk adjustment programs, minimizing audit concerns.
• Converged Outreach: Centralizes intervention activities and vendor interactions to ensure timely member engagement.
• Converged Patient Assessment: Supports providers in improving risk score accuracy with detailed documentation, minimizing disruption to their routine tasks.
• Converged Record Review: Streamlines medical record reviews, ensuring proper reimbursement and compliance risk management.

The software also integrates with the Inovalon Healthcare Data Lake, offering a unified platform for data storage, enrichment, and analysis. Additionally, the Electronic Record On Demand feature simplifies medical record retrieval, making it rapid, secure, and cost-effective.

Inovalon's solutions are trusted by 15 of the top U.S. health plans, boasting a 94% year-over-year customer satisfaction rate. With 25 years of NCQA HEDIS® measure certification and 19 years as an NQCA beta tester, the platform is well-established in the industry.

Overall, the Risk Adjustment Software aims to improve risk score accuracy, operational transparency, member outcomes, and economic performance, making it a comprehensive solution for healthcare professionals.