Risk Adjustment Support Services for Healthcare Payers
Risk Adjustment Support Services
Accurate risk adjustment is critical to ensuring fair reimbursement, financial stability, and regulatory confidence for healthcare payers. As documentation requirements grow more complex and audit scrutiny increases—particularly around RADV—many plans struggle with incomplete chart capture, inconsistent coding workflows, and limited visibility into risk score gaps. These challenges can lead to underreported risk, revenue leakage, and compliance exposure.
Ameridial supports healthcare payers with risk adjustment services designed to strengthen documentation integrity and operational discipline across the risk lifecycle. Our teams assist with chart retrieval coordination, documentation organization, coding workflow support, and audit preparedness—aligned to CMS requirements and payer-defined policies. By reinforcing structured processes and timely follow-ups, Ameridial helps plans improve risk score accuracy while maintaining confidence during audits and reviews.
Service Offerings for Risk Adjustment Support
Ameridial delivers standardized workflows, trained payer-focused teams, and compliance-ready processes to support comprehensive risk adjustment operations.
Chart Retrieval & Record Coordination
Coordinate retrieval of medical records from providers, track submissions, and ensure completeness for risk capture.
HCC Coding Workflow Support
Assist with organizing documentation, validating coding inputs, and supporting coder productivity within payer-defined guidelines.
Risk Gap Identification Assistance
Support identification of suspected or missing conditions using payer-supplied data and outreach lists.
Provider Outreach & Follow-Up Support
Manage non-clinical outreach to providers for record requests, clarification, and documentation follow-ups.
AI Solutions That Enhance Risk
Adjustment Performance
Ameridial integrates healthcare-focused AI tools to improve accuracy, visibility, and efficiency across risk adjustment operations.
Why Choose Ameridial for Risk Adjustment Support
Experience supporting Medicare Advantage, Medicaid, and commercial risk programs
Teams trained on HCC models, documentation standards, and audit requirements
Scalable delivery for seasonal risk adjustment cycles
Strong governance for chart management and audit readiness
HIPAA-compliant infrastructure and secure data handling
Actionable reporting aligned to risk score and compliance goals
PCI DSS 4.0.1
ISO 27001:2022
HIPAA Compliant
SOC 2 Type II
MBE
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Frequently Asked Questions (FAQs)
Does Ameridial perform medical coding or assign HCCs?
No. Ameridial supports non-clinical, administrative, and coordination workflows. All coding and risk determinations remain with certified coding professionals.
Which risk adjustment programs does Ameridial support?
We support Medicare Advantage, Medicaid risk programs, and payer-specific risk adjustment initiatives.
Can Ameridial help with RADV audit preparation?
Yes. We support documentation organization, chart validation, and audit response coordination.
Can Ameridial work within existing risk adjustment platforms?
Yes. Our teams align with payer-approved systems, registries, and workflows.
Is this service scalable during peak risk adjustment seasons?
Yes. Ameridial’s delivery model is designed to scale efficiently during annual and targeted risk cycles.
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