Healthcare risk adjustment
EDGE ASSIST
Inaccurate medical coding undermines member care and increases financial risk
Medical diagnoses are often incorrectly coded or not coded at all, adversely impacting your members’ healthcare outcomes and increasing your risk of audits, lawsuits, fines, and incorrect payments from risk adjustment programs.
Address errors and reduce risk with our comprehensive statistical model
Milliman IMPROVE analyzes detailed enrollment, medical, and pharmacy data, using a powerful algorithm to zero-in on coding errors and omissions. You get a clear, prioritized assessment of members whose conditions may have been under- or over-coded, along with financial impact estimates. With this information, you can match resources to risks and opportunities and reduce non-compliance with the False Claims Act or risk adjustment data validation (RADV) audit protocols.
Expertise
Milliman has the expertise to maintain your EDGE server, including contracting, configuring, acquiring CMS provisioning software, and registering. Upon successful completion of data processing and reconciliation, we will complete the submission process by properly transforming the data and loading it into the EDGE production environment.
Continuous process
We have a continuous process for reviewing and reconciling EDGE submissions and will work with you to ensure each submission passes our daily quality standards. We will also help you track your data over time and identify patterns, before your data reaches EDGE, to uncover signals of systemic weaknesses in your overall data management process.
Clarity
Additionally, Milliman brings clarity to error reports through precise summaries of these errors paired with direct action items as part of a larger strategic plan for correcting errors and improving data quality. We can identify the errors offering the most potential risk score value to help your team effectively deploy and allocate resources.
Related insight
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