Risk Adjustment

Solutions that cover every last detail.

Nationally recognized for our risk adjustment solutions, Wakely has a comprehensive and in-depth perspective of the most intricate workings of risk adjustment programs. We guide managed care plans and at-risk provider groups towards complete and accurate coding of members, allowing them to maintain operational integrity and optimize financial performance.

Wakely’s unique combination of actuarial, operational, strategic, and clinical expertise has made us a trusted risk adjustment partner for a wide range of healthcare plans and providers.  

Wakely’s Risk Adjustment Services

Wakely experts can support plans and providers with a full spectrum of services, including:

  • Member and provider level analytics
  • Clinical suspecting and insights
  • Clinical chart audits, both retrospectively and prospectively
  • Full end-to-end retrospective risk adjustment solutions
  • Estimation of risk adjustment transfers and accruals for year-end opinions, financial monitoring, and premium rate projections
  • Identification of discrepancies in External Data Gathering Environment (EDGE) data and reporting
  • Supplemental and chart chase efforts
  • Detailed reports identifying gaps and recapture opportunities
  • Analysis of financial drivers
  • Provider education and engagement

Unique products and tools.

Wakely has developed these industry-leading products and tools, which empower our clients to make highly informed strategic decisions.

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Wakely National Risk Adjustment Reporting (WNRAR)

Provides risk adjustment metrics from 35 states and 19 million lives.

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Risk Score Opportunities (RSO)

Identifies and prioritizes members who are most likely to have a condition that has not been coded.

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Risk Adjustment Payment & Identifying Discrepancies (RAPID)

Gets the most out of your EDGE data.

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Wakely Risk Assessment (WRA)

Provides a transparent, open-code, high-performance risk assessment model.

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Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)

Compares multiple data sources to provide transparency in risk score differences.

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Risk Adjusted Payments & Identifying Discrepancies for Medicare Advantage Plans (RAPID-M)

Helps plans optimize risk scores by identifying RAPS and EDS inconsistencies

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Healthcare Industry Insights

Michael CohenBy Michael Cohen
Michael CohenBy Michael Cohen