Talix Introduces Commercial Risk Adjustment Support for Providers and Health Plans

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- HYPERLINK "http://www.talix.com/" nTalix, Inc., a leading provider of risk analytics solutions for value-based care, announced its HYPERLINK "http://www.talix.com/products/risk-adjustment-for-payers/" nCoding InSight application now supports risk adjustment for health plans and providers participating in commercial programs such as the Affordable Care Act (ACA) health insurance exchanges. Coding InSight automates and streamlines risk adjustment coding processes for Medicare Advantage programs, Medicare accountable care organizations (ACOs), and now commercial plans by effectively uncovering missed or incorrect codes in patient encounters to close coding gaps, improve coding accuracy and improve efficiency (see also Talix).

"Healthcare organizations participating in the ACA exchanges face substantial financial challenges, often stemming from inaccurate risk scores that mean the difference between paying out rather than receiving transfer payments," said Dean Stephens, CEO of Talix. "Commercial support for Coding InSight gives plans and providers a more complete understanding of the true health and cost of their commercial population for better care planning, more accurate risk scores and improved financial performance."

Powered by Talix's data analytics platform, Coding InSight combines machine learning with advanced natural language processing (NLP) technology, sophisticated clinical rules and a proprietary medical taxonomy to comb intelligently through data from disparate sources - such as claims, electronic medical records and scanned charts - to accurately identify missed or inaccurate condition codes in patient data. The application then provides correct code recommendations based on the evidence found (e.g., diagnoses, assessments and treatments).

Commercial support for Coding InSight adds the ability for users to risk-stratify their commercial patients and members by metal level and age group. By supporting concurrent as well as prospective and retrospective coding, it enables providers and professional coders to easily create chase lists, identify high-risk patients, close coding gaps and document conditions more accurately. Health plans gain clearer insight on how their risk adjustment performance impacts transfer payments throughout the year so they can adjust their strategy accordingly.

Keywords for this news article include: Talix, Medicare, Health Policy, Investment and Finance.