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Risk Adjustment for Payers
Accurately capture patient risk to optimize plan reimbursements, ensure compliance, and drive value-based outcomes.
At Revix Health, we deliver comprehensive risk adjustment services that enable health plans to precisely reflect member risk, ensure regulatory compliance, and support sustainable financial performance.
By leveraging advanced analytics, robust data aggregation, and clinical coding expertise, we help payers improve risk score accuracy, meet CMS and ACA requirements, and proactively manage member health. Our solutions are aligned with value-based care principles to ensure the highest standards of quality and efficiency.
How We Help Healthcare Payers
Revix Health combines clinical, analytical, and regulatory expertise to drive risk adjustment accuracy and revenue integrity.
Our Comprehensive Risk Adjustment Solutions
Our payer-focused risk adjustment offerings span the full spectrum of services—from retrospective reviews to predictive analytics—to support compliant and optimized risk capture.
Retrospective Chart Reviews
Comprehensive reviews of historical medical records to identify missed or undocumented HCC codes. Our certified coding team ensures precise documentation that supports accurate risk scores and revenue optimization. Ensure complete and accurate capture of member risk—both retrospectively and in real time—through advanced analytics, AI-driven suspecting, and expert coding review.
What We Do
- Aggregate and audit historical EHR, claims, and encounter data
- Identify coding gaps and addenda opportunities
- Ensure HCC code compliance with CMS/HHS models
- Use AI to predict undocumented conditions and generate suspecting lists
Benefits
- Increase RAF score accuracy
- Mitigate revenue leakage
- Reduce audit risk with defensible documentation
- Align with CMS and ACA risk model requirements
HCC Coding & Compliance
Deliver accurate and compliant risk coding through certified expertise and automation. Our team ensures precise HCC assignment and regulatory alignment for every submission.
What We Do
- Apply ICD-10 codes to CMS-HCC and HHS-HCC risk models
- Perform multi-layer quality checks to ensure coding accuracy
- Support EDGE server and CMS RAPS/EDS submissions
- Maintain up-to-date coding standards and compliance protocols
Benefits
- Maximize reimbursement through correct risk capture
- Reduce audit exposure and coding errors
- Ensure timely and accurate data submission
- Stay current with regulatory updates and model changes
Analytics & Provider Enablement
Empower payers and providers with the tools, insights, and education needed to enhance performance and achieve risk-adjusted revenue goals.
What We Do
- Deliver real-time RAF tracking and predictive score modelling
- Provide dashboards for coding trends, gaps, and cohort insights
- Offer training, documentation guidelines, and performance feedback to providers
Benefits
- Support strategic forecasting and population risk stratification
- Strengthen payer-provider collaboration for better outcomes
- Drive continuous improvement in coding quality
- Align with value-based care and performance initiatives
Our Comprehensive Risk Adjustment Solutions
Our payer-focused risk adjustment offerings span the full spectrum of services—from retrospective reviews to predictive analytics—to support compliant and optimized risk capture.
Retrospective Chart Reviews
Comprehensive reviews of historical medical records to identify missed or undocumented HCC codes. Our certified coding team ensures precise documentation that supports accurate risk scores and revenue optimization. Ensure complete and accurate capture of member risk—both retrospectively and in real time—through advanced analytics, AI-driven suspecting, and expert coding review.
What We Do
- Aggregate and audit historical EHR, claims, and encounter data
- Identify coding gaps and addenda opportunities
- Ensure HCC code compliance with CMS/HHS models
- Use AI to predict undocumented conditions and generate suspecting lists
Benefits
- Increase RAF score accuracy
- Mitigate revenue leakage
- Reduce audit risk with defensible documentation
- Align with CMS and ACA risk model requirements
HCC Coding & Compliance
Deliver accurate and compliant risk coding through certified expertise and automation. Our team ensures precise HCC assignment and regulatory alignment for every submission.
What We Do
- Apply ICD-10 codes to CMS-HCC and HHS-HCC risk models
- Perform multi-layer quality checks to ensure coding accuracy
- Support EDGE server and CMS RAPS/EDS submissions
- Maintain up-to-date coding standards and compliance protocols
Benefits
- Maximize reimbursement through correct risk capture
- Reduce audit exposure and coding errors
- Ensure timely and accurate data submission
- Stay current with regulatory updates and model changes
Analytics & Provider Enablement
Empower payers and providers with the tools, insights, and education needed to enhance performance and achieve risk-adjusted revenue goals.
What We Do
- Deliver real-time RAF tracking and predictive score modelling
- Provide dashboards for coding trends, gaps, and cohort insights
- Offer training, documentation guidelines, and performance feedback to providers
Benefits
- Support strategic forecasting and population risk stratification
- Strengthen payer-provider collaboration for better outcomes
- Drive continuous improvement in coding quality
- Align with value-based care and performance initiatives
Our Client Stories
Why Revix Health is the Top Provider for Risk Adjustment Services?
AI-Powered Accuracy: Cutting-edge analytics and suspecting engines boost RAF precision.
Clinical + Coding Expertise: Dual-strength teams ensure quality, compliance, and financial results.
End-to-End Support: From coding to reporting, we cover the full risk adjustment lifecycle.
VBC-Ready: Our services align with value-based care to improve health and performance.
Latest Insights / Dive Deeper
FAQs
Risk adjustment ensures that health plans are reimbursed based on the complexity of their member population. It aligns payments with the actual risk profile, enabling fair compensation and sustainable plan management.
We support both CMS-HCC (Medicare Advantage) and HHS-HCC (ACA/Marketplace) models, and provide custom mapping services for other commercial risk models.
Yes, our suspecting engine uses AI and rules-based logic to identify likely undocumented HCCs, helping improve prospective and retrospective risk capture.
Yes, all our HCC coders are AHIMA or AAPC certified and trained in the latest CMS guidelines.
We maintain rigorous quality assurance protocols, conduct regular audits, and stay up to date with regulatory updates to ensure full compliance.
Yes, we provide advanced dashboards for RAF tracking, coding trends, and gap closure insights to support strategic planning.
Absolutely. Our platform and teams are equipped to scale for regional and national health plans, with flexible engagement models.
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