Risk Adjustment/Coding Toolkit

Recording: Case study: Health Alliance Medical Plan on risk adjustment data and reporting
A cross functional team of stakeholders from Health Alliance Medical Plan share an overview of their risk adjustment reporting systems, including their reconciliation process for RAPS, EDPS, and MAO-004, as well as their common reconciliation findings and how they operationalize addressing them.

Presentation: Case study - Health Alliance Medical Plan on risk adjustment data and reporting
A cross functional team of stakeholders from Health Alliance Medical Plan share an overview of their risk adjustment reporting systems, including their reconciliation process for RAPS, EDPS, and MAO-004, as well as their common reconciliation findings and how they operationalize addressing them.

Coding Work Group Case Studies: August 2017
Case studies shared by Providence Health Plan with the Coding Work Group for discussion of coding best practices.

Recording: Roundtable discussion - Data quality management program
Join your Alliance members for this round table discussion, scheduled at members' request in response to a very active discussion forum thread in June 2017! The group will be discussing data quality programs, and challenges health plans are facing in implementing and managing these programs, at the enterprise level, and locally.

Recording: Risk Adjustment Round table Discussion - July 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.

Coding Work Group Case Studies: July 2017
Case studies shared by Presbyterian Health Plan with the Coding Work Group for discussion of coding best practices.

Recording: Risk Adjustment Round table Discussion: June 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.

Presentation - WNRAR 2016 Report Results: A walking tour of the data for risk adjustment professionals
Wakely's WNRAR report is well known throughout the industry for the invaluable data it provides health plans operating in the ACA marketplaces. But oftentimes, this wealth of data is consumed solely by finance leaders and actuaries within the health plans. In this webinar, Wakely's team of experts provide a walking tour of one health plan's WNRAR report, with the needs of other stakeholders in mind.

Recording: 2017 Alliance Coding Work Group - HNE Case Studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.

Recording: Risk Adjustment Round table Discussion - May 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.

Building an analytics driven risk adjustment operation_CCHP
In a recent presentation at a RISE event, Alan Chuang outlined CCHP's journey to developing an analytics-driven approach to modernize risk adjustment within their plan.

Coding Work Group Case Studies: June 2017
Case studies shared by Health New England with the Coding Work Group for discussion of coding best practices.

Recording: 2017 Alliance Coding Work Group: Paramount case studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.

Recording: Risk Adjustment Round table Discussion April 2017
On the last Friday of each month, risk adjustment leaders from Alliance member health plans and their provider partner entities come together to discuss timely issues during an open round table discussion.

Coding Chronic Conditions from PMH
list of chronic conditions from the CMS Participant Guide that may be coded with evidence of TAMPER; this would include medications from a medication list that could only be prescribed for one of these conditions, even if the provider does not document the association in his or her assessment.

Recording: Case study - The RFP process for a risk adjustment vendor
In this encore presentation from the February 2017 Risk Adjustment value visit, MediGold shares more details regarding its search and selection process of a vendor to support the health plan's risk adjustment goals.

Presentation: Case study - The RFP process for a risk adjustment vendor
In this encore presentation from the February 2017 Risk Adjustment value visit, MediGold shares more details regarding its search and selection process of a vendor to support the health plan's risk adjustment goals.

Presentation: Risk Adjustment Round table Discussion: April 2017
Dean Ratzla, Actuary, Sentara Health Plans (Optima) shared the financial metrics used by his plan to communicate the financial value of its risk score optimization (RSO) activities and the formula for calculating the value of an incremental HCC.

Coding Work Group Case Studies:April 2017
Case studies shared by Paramount with the Coding Work Group for discussion of coding best practices.

2017 HHS RADV IVA Auditor Report: 2015 Audit
In q1 2017, the Health Plan Alliance invited member plans to share their experience with IVA vendors, and results were reported out in March 2017.