Active Practice Suite (APS)

The inteligenz Active Practice Suite offers custom data analysis allowing efficient management of medical practices. APS offers a host of reporting and decision support tools geared towards medical practice management.

Inteligenz Prospective Risk Adjustment Program-RAPSody™

With the passing of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, the Centers for Medicare and Medicaid Services (CMS) initiated the formal implementation of a fully risk-adjusted capitation reimbursement model. As a result, all Medicare Advantage (MA) plans and Prescription Drug (MAPD and PD) plans are financially dependent upon the specific documentation of each individual patient's diagnoses and comorbid conditions as classified within the highly specific CMS Hierarchical Condition Category (HCC) system.

Medicare Advantage plans must be proficient in accurately assessing and representing the comprehensive encounter, diagnostic, procedural, and pharmaceutical characteristics of enrollees. Comprehensive risk adjustment activities have become paramount to assuring appropriate severity adjusted reimbursement. The CMS requirement of accurate assessment, improvement, and reporting of factors that drive risk score calculation is critical. Failure to do so has both significant quality of care implications and critical financial ramifications.

To aid ATRIO Health Plan's risk adjustment activities, inteligenz is developing a suite of "end-to-end" Risk Adjustment solutions (RAPSody™) designed to identify, analyze, pursue, and document a plan's complete risk adjustment dataset not otherwise properly or fully captured by primary claims systems. RAPSody™ will demonstrate impressive return on investment for both financial and quality initiatives.

RAPSody™ will also assist ATRIO in efficiently and accurately implementing a system to optimally identify and capture the broad array of healthcare data and characteristics of its enrollees enabling superior quality improvement initiatives as well as full and accurate reimbursement from CMS, states, and other payment agencies. With the implementation of a fully risk-adjusted capitation reimbursement model, ATRIO is ultimately 100% financially dependent upon the specific documentation of each individual patient's diagnoses as classified within the CMS Hierarchical Condition Category (HCC) system. Failure to do so has significant financial ramifications.

inteli-match

Inteligenz provides third party recovery and liability services to managed care organizations with group health carriers. The inteli-match product searches eligibility data from all major group health carriers and matches results against managed care and medicaid eligible clients. Managed care organizations are able to utilize inteli-match services to recover payments made in error. Inteli-match can be employed to supplement health plans existing TPL efforts, or provide a fully outsourced solution.

Plan Insights (Suite)

Plan Insights Suite through inteligenz turns claims data into operational information for HMO's, IPA's and managed care clients. Our standard report views provide key indicators for physician profiling scenarios, disease management, utilization / quality management as well as prescription drug tracking and HEDIS reporting.