Risk Adjustment
The Optum Risk Adjustment solution provides a unique clinical orientation to risk adjustment activities to help Medicare Advantage organizations improve their financial and clinical outcomes. We apply deep experience with the latest CMS requirements and engage directly with providers to help them detect chronic diseases earlier and treat them more effectively, encourage continuous patient engagement, and accurately document disease progression to support appropriate reimbursement as well as timely, accurate RAPS submissions. Comprehensive capabilities include HCC coding and RAPS Encounter Data Processing System (EDPS) submissions, chart capture and review, prospective member and provider engagement, and RADV audit services.
OptumInsight can help your organization:
- Assure accurate documentation and coding for appropriate payment and leverage this information for clinical improvement
- Improve the scalability, cost, quality, and performance of population programs
- Detect chronic conditions earlier
- Understand the ongoing progression of chronic diseases in your population
