Streamline Member Enrollment and Stratify Risk
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.
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.