Risk Analytics

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Risk Adjustment HCC Challenges

Reveleer’s Feature-Rich Risk Analytics Solution examines all Source Data to Identify Suspect, Missing, or Incorrectly Coded Diagnosis Codes that are the foundation of your Risk Adjustment Factors. Risk Adjustment is far more than a Data Collection Project... It Drives Your Bottom Line

Reveleer’s Solution Can Help You With:

Revenue Optimization

  • Identification of GAPs and Data Leaks that may be decreasing RAPS Revenue
  • Identification of Missing HCC Codes Improves Outcomes and RAF Scores
  • Identification of Care GAPs Helps improve CMS ratings
  • Advanced Algorithms based on Population Specific Diseases and Target Chart Reviews to ensure Capture and Submission of all relevant HCC Diagnoses


  • Minimize Risk of CMS Penalties through RAPS Overpayment Analysis
  • Delete Analysis, Reverse Suspecting and Forecasting Financial Impact Helps Minimize Risk of CMS Penalties for Future Overpayments
  • Minimize Risk of CMS Overpayment Penalties through RAPS Filtering and Under-Filtering Analytics

Operational Efficiency

  • Member Tracking and Reporting identifies Members with Low Utilization
  • Assign and Schedule Chart Reviews – Track Audit Results
  • Submit Supplemental Chart Data to CMS

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  • Manage diagnosis data from both qualified and unqualified sources – including claims data, pharmacy encounters, and chart audits
  • Detect suspect missing diagnosis codes from historical encounter data
  • Calculate RAF scores based on varied collection and cut off dates
  • Forecast future CMS payment adjustments to plan revenue
  • Quickly enter and validate updated diagnosis codes
  • Configure a plan-specific suspecting rules library
  • Develop member level suspect lists of missing diagnosis codes and coding errors
  • Utilize substantial Report Library through both canned and ad hoc reporting