Risk Adjustment Toolkit

Episource’s Risk Adjustment Toolkit for Microsoft Excel delivers a comprehensive set of tools for analyzing Medicare Advantage risk adjustment data. Powered by epiAnalyst, the industry’s leading Risk Adjustment Analytics engine, the Excel add-in empowers health plans and provider groups to better understand their members’ risk scores, identify Dx/HCC gaps, and track risk program ROI.

Features:

● Calculate member risk scores and forecast premiums based on demographic and diagnosis information

● Perform analysis on Dx codes and/or HCCs

● Get descriptions and reference details about Dx codes or HCCs without leaving Excel

● Identify Year-over-Year HCC gaps and calculate their financial impacts

● Calculate impact and ROI of incremental codes identified in risk adjustment programs

● Full implementation of the CMS HCC Models from v22 to v24, including hierarchies, age/sex edits, and interaction codes

● Coverage of all risk factor types (Community, Duals/Disableds, Institutional,Newly Enrolled, etc.)

Episource: Simplifying Healthcare

Episource is the industry leader in Risk Adjustment software and solutions, serving the nation’s largest health plans and provider groups with analytics, submissions, chart retrieval and hcc coding, and health risk assessments. We arm our clients with elegantly simple data, tools, and insights; empowering them to navigate the chaos of the healthcare system.

EpiAnalyst: Episource’s Risk Adjustment Analytics and Workflow Platform

EpiAnalyst is a single platform to identify HCC Opportunities and launch RAF campaigns. Top Risk Adjustment programs use EpiAnalyst to stratify members and providers for opportunity, build chase lists for chart audits and health-risk assessments, create provider gap letters, and track the impact and ROI of these programs. EpiAnalyst simplifies Analytics, delivering these features in an intuitive web-based interface usable by executives, program managers, and data analysts alike.