Better Data, Faster.
Risk is the front end analytics that help establish a member demographic and health risk profile to ensure sales and enrollment compliance and improve risk-adjusted reimbursement. Information captured at the front end of the process is critical to maintain regulatory compliance, avoid fines and penalties, and determine a plan’s reimbursement, directly impacting risk-adjusted premiums.
MedHOK’s Risk modules streamline the member enrollment process and enforce CMS’ regulations regarding data capture, keeping health plans in compliance using sophisticated tracking capabilities. In April 2015, MedHOK acquired Continuum Performance Systems, Inc. (CPS), and integrated the MarketProminence™ software into the MedHOK platform. MarketProminence allows Medicare plans to automate tracking and management of all membership data throughout the relationship lifecycle, from prospecting and enrollment to billing, customer service and retention. MarketProminence also supports ongoing compliance for Medicare-Medicaid Plan (MMP), Medicaid, and commercial enrollment processing and member management.
MedHOK combines over 1,300 proprietary and third-party certified rules and algorithms to predict, identify and target all member health risks, gaps in care and co-morbid health conditions that form the basis for risk scores and risk-adjusted reimbursement, and triggers automated workflows within the member-centric record.
Scroll down or use the menu to view the modules in the Risk area of the MedHOK enterprise compliance software platform.