Proactive Risk Capture and Gap Closure with Prospective Risk Adjustment
Predict, prepare, and perform—transform risk adjustment from reactive to strategic with AI-driven pre-visit insights.
Turn Predictions Into Performance
Health Ovations’ Prospective Risk Adjustment leverages predictive analytics and clinical intelligence to flag undocumented conditions before patient visits. By arming providers with targeted member profiles and suspect conditions, we drive net-new HCC capture, improve care quality, and future-proof your program against compliance risks—all while optimizing revenue potential.
By shifting risk adjustment upstream, we turn what was once retrospective guesswork into proactive precision, ensuring no revenue opportunity slips through the cracks. This isn’t just gap closure—it’s gap prevention. By acting on pre-visit insights, you’re not just capturing risk; you’re redefining it.
Features
Predict risk score trajectories and HCC opportunities with high accuracy to prioritize interventions.
AI-Driven RAF Forecasting
Identify high-risk members and clinical suspect opportunities by care setting or PCP attribution.
Member-Level Risk Segmentation
Track chart status, coder productivity, and SLA compliance with drill-down to individual providers or clinics.
Real-Time Performance Dashboards
Build and export reports by provider, plan, HCC, or date range—all with Excel, PDF, or API options.
Customizable Reporting Hub
RADV simulations and dual-pass audit tracking minimize denials and prep for CMS reviews.
Audit-Ready Compliance Tools
HIPAA-compliant platform with encrypted data feeds and granular user permissions.
Secure, Role-Based Access
Benefits
Prospective Risk Adjustment doesn’t just improve accuracy—it transforms how you capture risk, deliver care, and protect revenue.
Predict Risk, Prevent Leakage
Catch suspect conditions early with high prediction accuracy, reducing post-visit coding gaps and revenue loss.
Quality Care Meets Quality Data
Enable earlier interventions for high-risk members while simultaneously improving documentation completeness.
Audit-Proof Your Program
Proactive gap closure minimizes compliance risks and ensures every HCC submission is defensible and data-backed.
Request Additional Information
Start a conversation to expand coding capacity, RAF lift, or prepare for HCC changes.