Comprehensive Risk Adjustment

Comprehensive Risk Adjustment

Risk Adjustment

Medicare Risk Adjustment (CMS-HCC v23 & v24 )

Cozeva’s Risk Adjustment engine calculates RAF and analyzes HCC scores. We have the most up-to-date and accurate models, which look at billion of events spanning multiple years and include everything from claims & charts to prescriptions & lab test results.

Commercial Risk Adjustment (ACA) 

Cozeva puts into the line of sight to providers suspect conditions for the Commercial Exchange and ACA populations using HHS-HCC Risk Model.

Medicaid Risk Adjustment (CDPS / Medicaid Rx)

Cozeva also computes risk using CDPS/Medicaid Rx for Medicaid populations.

Real-time Risk Reports

Generate custom suspect files and reports, and visualize data through customizable analytics and reporting. Our dashboards engage providers directly.

Employ Proprietary Algorithms

Identify risk trends by individual providers, physician organizations, or member demographics to analyze utilization by RAF and drill down to individual cases to identify areas for improved care coordination.

No Black-Box Suspect Models

Cozeva’s Suspect Model workbook shows each feature by weight, odds ratio, precision value, recall value, providing complete transparency.

Suspect Analytics

NLP-Enabled Chart Review + Coding

Extract from Free Text in C-CDAs

Apply Natural Language Processing (NLP) to any free text in Consolidated-Clinical Document. Architecture (C-CDAs) to help close HCC gaps. Improve your accuracy over time by profiling the source of the C-CDAs.

Extract from Scanned Charts

Apply deep learning techniques to extract text from scanned documents and highlight documents to quickly convert to structured data.

Increase ROI 

Reduce chart chases by retrieving charts automatically via Cozeva’s secure gateway and increase quality coding by listing specific codes and reducing the need for clinical chart review.

Risk Revenue Recovery (RAPS Return, MAO-004, MMR, MOR)

Map and submit RAPS/EDS files to CMS specifications, and refresh data with files returned by CMS. Rectify gaps between RAPS and EDS submission.

Minimize Financial Risk 

Stratify population risk by health plan, region, group, and practice, allowing you to profile patients according to financial risk. Monitor trends in risk and benchmark your population risk with national and regional rates.

RAPS/EDS Management

Network Performance Management

Optimize Quality Scores

Clinical support staff and teams can use the Cozeva performance metrics management tools to track performance by line of business, clinical measure set, health plan, etc. Identify outliers at any level and take steps to improve scores. 

Focus on the Important

Individual provider progress is monitored at the practice level and additional interventions can be deployed as necessary.

Social Comparisons 

Network comparisons provide tangible motivators to drive higher performance and bend the cost curve. Visual appeal, real-time feedback, accuracy, and a simple user design will ensure that your providers keep logging in.