Health Plans
At Annova Solutions, we empower health plans with technology-driven solutions to optimize risk adjustment, compliance, and financial performance. Our expertise spans medical record retrieval, HCC coding, HEDIS abstraction, and revenue cycle management, ensuring accuracy, efficiency, and regulatory adherence. By streamlining operations and enhancing member outcomes, we help health plans reduce audit risks, improve quality reporting, and maximize revenue in an evolving healthcare landscape.
Services for Health Plans
Medical Records Retrieval
Secure and efficient retrieval of medical records to support risk adjustment, quality reporting, and compliance requirements.
Quality Measures Abstraction
Accurate data abstraction for HEDIS, STAR ratings, and other quality programs, helping health plans meet performance benchmarks and improve member outcomes.
HCC Coding
Comprehensive risk adjustment coding to enhance accuracy, compliance, and financial performance across multiple programs:
- Medicare HCC, HHS-HCC, and Medicaid Risk Adjustment – Expertise in coding for CMS, ACA, and state-based risk adjustment programs to ensure optimal risk capture.
- Retrospective Reviews – Validate submitted claims data, capture missed HCCs, and generate a recapture list for the following year to optimize risk scores.
- Prospective & Concurrent Reviews – Work on recapture lists, integrate CDI strategies, and provide pre-encounter preparation along with post-encounter support to improve documentation completeness and accuracy.
Mock RADV & OIG Audits
Targeted audits designed to mimic RADV and OIG reviews, helping payers assess their documentation of high-risk conditions and identify potential compliance risks before an official audit.
Chart Retrieval
We specialize in chart retrieval for risk adjustment services, ensuring accurate medical record documentation for HCC coding and RAF score calculations. Our solutions help payers meet CMS compliance requirements, optimize financial performance, and mitigate audit risks effectively.
HCC Coding
Our risk adjustment coding services empower payers with precise HCC coding and RAF score optimization for Medicare Advantage, ACA Health Exchange, and Medicaid plans. We ensure CMS and HHS compliance, supporting financial stability while maintaining regulatory excellence.
Retrospective Coding
We enhance risk adjustment accuracy through compliant retrospective coding, helping payers optimize financial performance, align with regulatory requirements, and prepare for audits like RADV, reducing overall risk exposure.
Concurrent Coding
Our concurrent coding solutions ensure real-time capture of risk-adjusting diagnoses, enabling payers to maintain compliance, reduce claim denials, and improve performance in value-based care models.
HEDIS, Stars & Quality Measures
We help payers meet HEDIS compliance and quality benchmarks by ensuring accurate, timely abstraction of performance measures. Our services enhance regulatory alignment and improve quality scores for value-based care initiatives.
Member Engagement Services
We partner with payers to enhance member engagement through data-driven strategies, improving preventive care adherence, health outcomes, and member satisfaction. Our solutions ensure seamless care coordination and support value-based care models.
Revenue Cycle Management
Our RCM services optimize payment accuracy, denial management, and claims processing, helping payers reduce claim rejections, ensure regulatory compliance, and streamline reimbursement processes for financial efficiency.
Social Determinants of Health (SDOH)
We assist payers in integrating SDOH data into risk adjustment models, quality initiatives, and STAR ratings strategies. By leveraging advanced analytics and predictive modeling, we help health plans improve population health insights, drive equitable healthcare strategies, and enhance member engagement.
Benefits for Health Plans
Benefits for Health Plans
At Annova Solutions, we empower payers to achieve superior financial and clinical outcomes through our comprehensive suite of services.
Key Benefits:
- Optimized Financial Performance: Our accurate coding and medical record retrieval services enhance reimbursement processes, ensuring payers receive appropriate compensation.
- Regulatory Compliance: We assist in navigating complex regulatory landscapes, ensuring adherence to CMS guidelines and minimizing audit risks.
- Enhanced Member Satisfaction: By supporting care appropriateness and quality reporting, we help improve member experiences and satisfaction.
- Scalable Solutions: Our flexible service models allow payers to scale operations efficiently, adapting to evolving healthcare demands.
FAQs
Annova offers comprehensive risk adjustment services, including retrospective and concurrent coding reviews. Our certified coders identify and validate diagnoses, ensuring accurate risk assessments and optimized revenue.
Yes, we provide HEDIS chart abstraction services, leveraging our team of experienced professionals to ensure precise data collection and reporting, thereby supporting quality improvement initiatives.
Annova is committed to data security, adhering to SOC II Type II and ISO 27001 certifications. Our stringent security protocols ensure compliance with industry standards, safeguarding sensitive information.
We offer comprehensive provider and member communication services, facilitating effective engagement strategies that enhance member satisfaction and support care appropriateness.
Absolutely. Our team has achieved unmatched completion rates in medical record retrieval, ensuring timely and efficient access to necessary records for accurate coding and compliance.