Complete Risk Adjustment Management.
Identify prospective HCC coding opportunities, close retrospective coding gaps, and predict RAF scores — all in the platform purpose-built for risk-bearing organizations.
Accurate Risk Capture Drives Every Dollar of Your Revenue
Risk adjustment is the single largest revenue driver for Medicare Advantage plans — and the most frequently under-optimized. A member with diabetes, CHF, and CKD who is coded only for diabetes may represent several thousand dollars of annual revenue gap. Multiply that across thousands of members with similar coding deficiencies, and the financial impact is material.
EnsureRAF™ combines predictive HCC suspect identification, retrospective coding review, and RAF score modeling to help health plans, ACOs, and risk-bearing provider groups capture every dollar of legitimate revenue while maintaining coding accuracy and CMS compliance.
End-to-End Risk Adjustment Management
Predictive Prospective HCC Identification
Machine learning models analyze claims, labs, pharmacy data, and clinical notes to identify members with probable HCC conditions not yet documented — before the visit window closes.
Retrospective Coding Review
Identify services rendered but not coded, or conditions documented in prior years not recaptured this year. Support chart chase campaigns with prioritized member and provider lists.
RAF Score Prediction & Modeling
Predict RAF scores — including for suspected but un-coded conditions — to model revenue projections, flag high-risk members, and prioritize outreach by potential revenue impact.
Provider Coding Analytics
Identify provider-level coding patterns, education opportunities, and outliers. Track HCC capture rates by provider group, specialty, and facility.
Multi-Program Risk Adjustment Models
Purpose-built risk adjustment models for Medicare Advantage, ACA/Marketplace, and PACE programs — each configured to the specific HCC methodology and payment rules of that program.
ACA Risk Pool Analytics
ACA marketplace risk adjustment transfer analysis and optimization. Model transfer payment scenarios with full transparency into your risk pool position.
Recover Revenue You've Already Earned
See how EnsureRAF™ identifies HCC coding gaps across your Medicare Advantage, PACE, and ACA populations — and models the exact revenue impact of closing them.