risk adjustment

Advize Health specializes in collaborating with health plans to combat fraud, waste, and abuse. Its team of subject matter experts has diverse backgrounds in Special Investigation Unit (SIU) and Payment Integrity, offering customized, cost-effective services. The company also emphasizes community outreach initiatives including medical debt relief, scholarships, healthcare financial literacy, emergency relief, and mentorship opportunities.

audit backlog supportcoding and medical reviewscorrective action plan implementationdata analysis and analyticsDRG and readmission auditsevaluation and trainingfraud investigationslitigation and compliance supportOIG investigations and self-disclosuresoutsourced SIU servicespayment integrity consultingprovider educationrecord reviewsSIU staffing augmentationsubject matter expert testimony

ATTAC Consulting Group is a healthcare consulting firm specializing in operations and healthcare compliance solutions for health insurers and managed care organizations. It provides advisory, auditing, consulting, technology and business operations solutions to Medicare Advantage and Part D plans, Medicaid plans and MCOs, commercial insurers, Marketplace plans, IPAs, ACOs and health systems.

AuditingBusiness Transformationcompliance program designinterim staffingmedical record codingproject managementprovider network managementtechnology implementationtraining

CBIZ Optumas is a health care consulting firm comprised of economists, actuaries, clinicians, strategists and consultants. It works with state and local governments, public and private employers, and health care providers on health and welfare programs, offering actuarial consulting, health care analytics, and BI/dashboards to help clients design efficient health care reform initiatives.

Actuarial certificationActuarial rate settingBenefit pricingBI/dashboardsclaims analysisData AnalyticsMedicare repricing

Cloud Harbor Economics, LLC is an economics consulting firm specializing in advanced data analytics, quantitative modeling, forecasting, and research in health economics and policy. Founded in 2019 inside the DC Beltway and now headquartered in the greater Houston metro area, it has served multiple federal government agencies and private-sector clients throughout the United States. Its team includes Ph.D. economists, medical doctors, policy analysts, data scientists, programmers, and project managers.

AI-powered toolscausal inferenceData Analyticsforecastinghealth economics researchHelp desk supportpayment system developmentpolicy analysispredictive modelingquality measurementquantitative modelingregression analysisTime-series forecastingtraining development

Edifecs is now Cotiviti, delivering connected, accurate, and efficient healthcare through market-leading interoperability, payment integrity, and health enablement infrastructure that connects data, decisions, and outcomes. The company serves payers, government healthcare, providers, insurance, and retail & enterprise markets.

data mininghealth enablement infrastructureinteroperabilitymedical record codingmedical record retrievalpayment integrity

Founded in 2013, Salud Actuarial Consulting specializes in actuarial, financial, and health policy consulting for publicly funded health programs. The firm helps clients understand complex regulatory issues and solve financial matters associated with designing and administering managed care programs, with extensive experience in acute care and long-term care program design, financing decisions, and managed care rate setting in Medicare and Medicaid product lines.

actuarial consultingcapitation rate settingclaims data analysisdata analytics (SQL/WPS/SAS)expert witness testimonyfinancial reportingIBNP analysis

Focus Care is a Boston-based, privately-owned national healthcare services company that has been in business for more than 22 years. It provides in-home and virtual Comprehensive Health Assessments, risk adjustment, quality gap closure, Annual Wellness Visits, telehealth, and member engagement solutions for health plans, ACOs, physician offices, and PACE networks. It operates a 24/7 HIPAA-compliant call center and a national provider network of 11,000 practitioners.

call center operationscare managementclinical documentation (AI)in-home health assessmentsmember engagementremote monitoringscheduling and outreachvirtual/telehealth assessments