The VDT Affinitē Risk Adjustment module includes:
• Multi-user access to the stand-alone Risk Adjustment Module of the Affinitē platform for CMS HCC Risk Adjustment. With Affinitē Risk, HEALTH PLAN NAME will receive the following:
o Implementation
o Data Integration and Analytics, Warehousing and Daily Processing
o Dashboard high-level insights including the status of HCC capture, the performance of providers and provider groups, and HCC opportunities
o Reporting
o Estimated RAF scores at the member, provider, and provider group level based on claims data
o Estimated member level RAF score build-up incorporating demographics, acute and chronic HCCs, disease interactions, and HCC payment count
o Identification of HCCs obtained from claims data and chart review
o Visibility into detailed claim data, highlighting HCCs that impact the RAF score
o Visibility into detailed pharmacy data including refill status and ordering provider
o Comparison of estimated RAF scores for current and prior year(s)
o Identification of Missing HCCs (year-over-year gaps) for all open years at the member level
o Member level identification of possible suspect HCCs based on claims and supplemental data for all open years.
o Preparation of RAPS claim submission files in CMS required format
o Preparation of RAPS supplemental submission files from chart review in CMS required format
o Ability to monitor providers and provider group related to HCC capture, HCC gaps and average RAF score
o Train-the-trainer training and support on the VDT Affinitē solution
