This morning, Talix proudly announced that our Coding InSight solution now supports commercial risk adjustment for health plans and providers participating in the Affordable Care Act (ACA) health insurance exchanges. Throughout 2016, several high-profile insurers struggled with their ACA lines of business, leading some to reduce their exchange plan offerings and others to exit the exchanges completely. A major challenge for these and other health plans stems in part from problems with their risk adjustment programs that can lead to serious revenue shortfalls. Essentially, without a comprehensive view of the health of their commercial members, plans may set inaccurate risk scores that mean the difference between paying out rather than receiving transfer payments.
Talix’s Coding InSight addresses this issue by automating and streamlining the time-consuming and error-prone manual chart review process. The commercial support feature adds the ability for users to risk-stratify their commercial patients and members by metal level and age group. The application also supports concurrent as well as prospective and retrospective coding, so providers and professional coders can easily create chase lists, identify their high-risk patients, close coding gaps and document conditions more accurately. With Coding InSight, plans will have a more complete view of the health and associated cost of their commercial population and much clearer insight into how their risk adjustment performance impacts transfer payments throughout the year, so they can adjust their strategy accordingly.
Talix is working constantly to enhance and expand our risk and quality analytics offerings. Commercial support for Coding InSight is just the latest example of our commitment to providing leading-edge, best-in-class solutions to help payers, providers and accountable care organizations address the challenges of value-based care. It certainly won’t be the last.
To learn more about how Coding InSight can help you improve your commercial risk adjustment results, contact us at firstname.lastname@example.org.