System-Wide Solutions

Whether you’re looking for a single risk adjustment service or a full-service partner, Cognisight has the trusted expertise to meet your risk adjustment needs with our industry leading results.

We partner to transform medical record data into meaningful, actionable information.

Medicare Advantage Plans

Medicaid Managed Care Plans

PACE Programs

Accountable Care Organizations

Commercial Health Issuers

Independent Practice Associations

DATA & TECHNOLOGY

Cognisight believes that data analytics are the foundation for successful risk adjustment—we incorporate proprietary data analytics that are tailored to each market and solution. Through innovation and technology, our goal is to reduce the burden of medical record acquisition and review without losing the focus on quality.

MEDICAL RECORD ACQUISITION

Cognisight understands the importance of accurate patient data for risk adjustment processes. As a provider-owned organization, Cognisight has a balanced approach to minimize provider abrasion while offering secure and dynamic medical record acquisition methods. At Cognisight, we have proven success receiving over 95% of the medical records requested.

MEDICAL RECORD REVIEWS

Cognisight’s team of medical record reviewers—with an average of 15+ years of experience—is comprised of Certified Risk Adjustment Coders (CRC), Registered Health Information Technologists (RHIT), and Certified Coding Specialists (CCS).

BIDIRECTIONAL

An analytically driven medical record review service focusing on revenue potential and protection. This service looks for supporting documentation to verify previously submitted diagnosis codes and ensure all existing codes are captured for risk adjustment.

RETROSPECTIVE

A retrospective medical record review with a unique approach. Backed by industry-leading analytics, this multiphase review provides a roadmap for increasing accuracy and ensuring all existing codes are captured, thereby maximizing risk adjustment revenue.

VERIFICATION

A strategically driven audit leveraging our analytic engine and stratification approach to verify previously submitted diagnoses and provide risk-aware health plans with revenue protection prior to an audit.

CONCURRENT

A series of medical record reviews that are conducted during the current benefit year that allow for the optimization of all coding and documentation opportunities.

AUDIT SUPPORT

Cognisight is devoted to ensuring client data meets the highest integrity standards possible through our regulatory audit support solutions.

HHS-RADV Initial Validation Audits (IVA)

Cognisight has been providing HHS-RADV services since the inception of the audit in 2015. Our complete, operationalized solution includes medical record retrieval, Issuer Documentation, verification and new diagnosis capture, Demographic and Enrollment Data Validation, Health Status Data Validation, RXC Data Validation, project tracking, reporting, data submission, and appeals support combined with an unparalleled account management team.

National & Contract-Level RADV (Risk Adjustment Data Validation) Audit Support

Supporting RADV audits since 2007, our comprehensive RADV audit support includes developing target lists, medical record acquisition, and review.

HEALTH ASSESSMENTS

At Cognisight, we know that information in medical records and claims may not accurately reflect the member’s health status. Cognisight provides customized in-home health assessments with qualified nurse practitioners or physician assistants. These annual wellness visits are designed to accurately reflect members’ health status, providing any essential missing clinical data. This process provides an opportunity to ensure accurate and comprehensive risk adjustment results, improve quality measures, and close care gaps.

EDUCATION & TRAINING

Cognisight offers customizable training solutions to ensure providers and coders fully understand the intricacies of the ever-changing risk adjustment landscape—models, rules and regulations, coding guidelines, and documentation requirements. Sample sessions include The Fundamentals of Risk Adjustment, Real-Time Coding & Education, and HCC Documentation Tips & Coding Best Practices.

Join the Cognisight Team

If you’re looking to join a thriving business and risk adjustment leader, we’ve got the opportunity for you.

About Cognisight

Cognisight is a risk adjustment industry leader, providing world-class solutions to healthcare payers and providers. Founded in 2006, Cognisight is a wholly owned subsidiary of the Greater Rochester Independent Practice Association (GRIPA) and part of Rochester Regional Health.

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