Active Practice Suite (APS)
The inteligenz Active Practice Suite offers custom data analysis allowing you to manage your business more effectively. Inteligenz offers medical billing reporting for medical and pharmacy claim detail. In addition, we offer medical practices/ physicians the ability to view billing reports and executive dashboards they can use to manage their entire office.
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 data match services with group health carriers. This is a program we started developing over a year ago, following the passage of ORS 743.847 - SB 153. Our search program for our customers was designed to find out when their past and current members had concurrent coverage with group health carriers. We pursue recoveries for our clients for services going back three years, as allowed by the statute. This allows our clients to recover significant amounts of payments, and also allows them to practice third-party cost avoidance.
Plan Insights (Suite)
Data Analysis is a necessity when making wise business decisions. The Plan Insights Suite thru 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.
