Surviving today’s environment as an insurer feels a bit like trying to escape from a pressure cooker. Between regulatory uncertainty, increasing amounts of patient data, industry consolidation, and an aging population, health plans are being pulled to the breaking point by numerous factors.
Healthy Fidelity’s NLP-enabled risk adjustment solution offers insurers a complete and holistic view cutting across all risk adjustment activities to usher in the next generation of risk determination. Break free from the operational constraints to better project, detect, and capture the true risk of your membership across all lines of business.
Transform Risk-Adjustment Operations
with our NLP-Enabled Coding Solution to:
Lumanent Retrospective Review empowers coders with a clean and prioritized queue to complete two-way records review for evidence-derived up-side and down-side retrospective coding. Included “Manager Mode” provides QA capabilities to ensure that your submission is both complete and accurate.
Lower Coding Costs
After our NLP weeds out the roughly 40-50% of records without opportunities, Lumanent Retrospective Review directs coders to only those records requiring a manual review; highlighting the relevant sections of the chart containing the evidence and reducing the time required to identify additional codes to be captured.
Effortlessly Scale Across Populations
Our solution works across and understands the nuances of risk-adjusted claims reimbursement for different member populations. Transform an otherwise manual and disparate risk adjustment process into an integrated workflow across Medicare Advantage, ACA Commercial, Managed Medicaid, or Medicare ACO programs.
How to Get There
With Health Fidelity, complete and accurate risk capture is attainable with our modular application suite, customizable to your specific needs and readiness:
With Lumanent Retrospective Review, improve the productivity and efficiency of your internal coding staff to manage first or second pass reviews.
Consolidated Client Outcomes
Increase in Coder Productivity
Increase in Risk Capture
Decrease in Costs