Concurrent Risk
Adjustment

Concurrent Risk Adjustment transforms the risk adjustment process by supporting identification of potential documentation opportunities at the earliest possible moment—right within the claims pipeline.

With near real‑time automation and minimal disruption to provider workflows, we deliver a smarter, faster, and more scalable approach to documentation review processes and risk capture.

Open coding gaps can slip with retrospective projects due to unretrievable charts, limited suspecting, and operational constraints. Concurrent Risk Adjustment directly addresses the challenges by shifting gap detection and review to the moment a claim is submitted, enabling plans to identify potential documentation gaps for provider review prior to adjudication based on prior claims history. Our solution analyzes the full digital footprint of each claim to capture all relevant information. By returning automated messages of acknowledgement with clear, gap-specific notifications prompting review, the solution provides notifications that may support provider review and claim update processes. This proactive approach not only reduces administrative burden but also improves accuracy, forecast visibility, and ensures plans can accurately reflect member risk even when downstream data access is constrained.

Concurrent Risk Adjustment benefits

Concurrent Risk Adjustment operates directly inside the claims pipeline; earlier in the workflow than traditional risk-adjustment solutions. With a design that is both clearinghouse‑agnostic and EMR‑agnostic, plans can deploy at scale with minimal integrations, limited workflow disruption, and configurable controls and engagement strategies designed to reduce provider abrasion. Unlike retrospective tools that rely on incomplete data or manual processes, Concurrent Risk Adjustment leverages the entire digital lifecycle of a claim—submitted, returned, and edited—to deliver unmatched visibility and precision.

By combining real‑time interception, automation, and comprehensive data intelligence, Concurrent Risk Adjustment delivers a level of speed, accuracy, and scalability that traditional gap‑closure methods are not designed to match.