Change Healthcare today introduced Dx Gap Advisor, a new automated analytics solution on the company’s Intelligent Healthcare Network that helps health plans and their providers ensure complete, accurate, and compliant risk adjustment data capture. Dx Gap Advisor automatically identifies possible undocumented diagnosis codes and alerts providers to appropriately address the identified risk adjustment gaps. As a result, health plans can avoid manual chart reviews, ensure accurate and complete data, improve payer-provider collaboration, and increase provider satisfaction.
Dx Gap Advisors Overview
Dx Gap Advisor embeds the Change Healthcare Risk View analytics scoring engine in the company’s Intelligent Healthcare Network to identify potentially missing diagnosis codes and efficiently and effectively message providers to review and confirm an individual’s medical record information to help ensure complete and accurate diagnosis data capture. Missing diagnosis codes for chronic conditions are identified, and targeted real-time messages are delivered to providers. Alert messages are accompanied by educational components such as collaborative, non-abrasive, proactive provider letters and webinars, to help create an improved provider experience and help enhance provider loyalty.
Pitfalls of Risk-Adjusted Chronic Condition Care Gaps
Identifying risk-adjusted chronic condition care gaps traditionally involves a payer’s auditor manually reviewing patient medical records in providers’ billing offices. These retrospective reviews are often time-consuming, prone to human error, and may increase provider abrasion. In addition, risk-adjustable diagnosis data may go uncaptured when charts are irretrievable. Additionally, some Medicaid programs do not allow retrospective or supplemental submissions. As a result, risk-adjustment data submissions are delayed, often by over 12 months, or missed entirely.
Dx Gap Advisor Benefits
With Dx Gap Advisor, payers benefit from Risk View’s proven, advanced analytics developed and continuously updated over many years as well as the claims data from Change Healthcare’s Intelligent Healthcare Network to transform existing cumbersome and time-consuming industry standard processes into an automated, efficient and effective approach.
“Accurate payer reimbursement for risk-adjusted populations requires complete and accurate diagnosis coding, which can be burdensome and complex for providers. Dx Gap Advisor helps solve this by informing providers of a patient’s prior history of chronic diagnoses directly within the clinical workflow, thereby reducing coding complexity,” said Rod O’Reilly, president, Software & Analytics, Change Healthcare. “Payers now can ensure more accurate, complete, and compliant risk-adjusted diagnosis data for their members, and providers are no longer inundated with requests from payers for chart reviews.”