Full-spectrum integrated risk adjustment solutions



Big data is only as useful as the human decisions behind it. Our team of highly experienced subject matter experts combined with concierge level attention and support, we help guide you in making data driven decisions to ensure an effective and efficient risk adjustment initiative. We bring technology and process together to accurately document member disease burden to support the appropriate risk adjusted reimbursement to care for the members you serve across Commercial ACA, Medicare Advantage, and Managed Medicaid markets.

Retrospective Risk Adjustment

Serving regional and community-based health plans, our field-based team supports health plans’ needs to retrieve medical records, review clinical content, and ensure accurate coding of your members’ medical conditions. We focus on your success, and use a NEAT approach:

  • Nimble. We help you manage data, resolve errors and provide support throughout the submissions process.
  • Efficient. Offering time and attention of our subject matter experts, we help you avoid waste and realize revenue faster. We find missing data and facilitate remediation of under-reported risk scores.
  • Accurate. Our industry leading code capture and accuracy rate ensures accurate documentation.
  • Transparent. We provide timely reports in straightforward, familiar formats to keep your business process running smoothly.
  • # HCCs captured
  • 90+% retrieval rates
  • 100% certified coders (CPCP, CRC, and/or CCS)
  • Currently contracted with [26] risk-bearing healthcare organizations
PopHealthCare also provides:
  • RADV audit support: CMS audits and mitigation
  • Submission of RAPS, EDPS, and EDGE files to CMS
  • Resolution of data submission errors and analysis of root causes
  • State Specific Data analytics as needed
Ongoing Claim Review

Monitoring claims and encounter data for an expected visit, based on historical care and provider documentation patterns.

Retrospective Chart Review

An existing claim exhibits high likelihood that documentation of HCC is present in the medical record, targeting for review.

In-Office Visit Facilitation

Historical care patterns show that a provider relationship is present, but there is a need to promote a visit to occur in the calendar year.

In-Home Assessment

If no provider relationship is present and there is a high cost-benefit opportunity, the member is targeted for an in-home visit.

Getting Started

Contact Us today for a free consultation and analysis of your data.

Contact Us

For more information regarding RiskSight®, please fill out the form below.