Bring Risk Adjustment to the Point of Care
Prospective Risk Adjustment brings risk adjustment forward to surface suspected conditions and open gaps before a member visits their provider. By connecting health plans with providers before the measurement year closes, providers are equipped with actionable insight at the point of care, improving documentation accuracy the first time and building a program that grows more efficient every year.
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What Makes Us Different
Point-of-Care Gap Identification for Suspected Conditions
Prospective Gap Review uses Centers for Medicare and Medicaid Services (CMS) risk adjustment models and certified coder review to flag suspected conditions ahead of each member's next encounter. Rather than chasing gaps after the fact, your team gets a head start that carries forward into every future measurement year.
Provider Engagement Coordination
Provider Engagement Coordination delivers Clinical Documentation Improvement (CDI) alerts for Hierarchical Condition Category (HCC) and Healthcare Effectiveness Data and Information Set (HEDIS®) gaps directly to providers at the point of care. Whether your network relies on electronic health record integration, remote outreach, or on-site support, this program folds within the providers' workflow and scales alongside your network as it grows.
Concurrent Coder Review Closes Gaps with Confidence
Certified coders review provider responses and progress notes in real time, confirming that every gap closure is accurate, compliant, and properly documented. This isn't a post-processing step; it happens as providers respond, so accuracy holds steady no matter how much your membership grows.
Electronic Provider Engagement
Real-time EMR integration delivers CDI alerts directly into the provider's existing workflow at the point of care.
On-Site Provider Engagement
Dedicated onsite support embed directly in provider offices to close care and documentation gaps through peer-to-peer collaboration.
Remote Provider Engagement
Digital engagement extends coordinated CDI review and coder support to distributed or lower-infrastructure provider networks.
Revenue Align Edge Suite
Revenue Align Edge
Revenue Align Edge enables proactive management and stronger compliance across the payer enterprise by giving payers a clear, data driven picture of risk adjustment, aligning prospective and retrospective risk so you can capture accurate, complete, and compliant documentation with confidence.
Retrospective Risk Adjustment
Automated chart review and audit-ready submission to capture every documented condition.
What Outcomes Can Health Plans Expect?
Revenue Align Edge: Prospective Risk Adjustment delivers measurable returns across the client base. These numbers reflect what health plans are achieving across programs today. The combination of prospective gap targeting, flexible provider engagement, and concurrent coder review creates a compounding effect: more accurate documentation leads to more accurate risk scores that are properly aligned with the members health plans serve.