- Accurate HCC Capture
- Optimized RAF Performance
- Audit-Ready Compliance
Advanced Risk Adjustment Solutions
Accurate risk scoring is the foundation of sustainable performance. Valiant Lifecare combines clinical expertise, data-driven insights, and precise documentation workflows to uncover missed conditions, validate HCCs, and strengthen RAF integrity across your population. From real-time concurrent reviews to targeted prospective outreach and comprehensive retrospective audits, our programs help health plans and providers improve capture completeness, reduce audit exposure, and achieve measurable improvement in financial and quality outcomes.
Our Risk Adjustment Services
Concurrent Risk Review
Real-time chart review during inpatient and outpatient episodes to capture undocumented or under-documented diagnoses before claims are finalized.
Prospective Risk Review
Proactive chart screening and outreach to identify missed HCCs and close documentation gaps ahead of submission cycles.
Retrospective Risk Review
Comprehensive retrospective abstraction and validation to capture missed diagnoses and support RAF reconciliation and appeals.
HCC Validation & Coding Review
Coder-led HCC validation linked to clinical documentation improvement recommendations and coding correction workflows.
RAF Optimization & Modeling
Data-driven RAF modeling and scenario planning to quantify impact, forecast revenue, and prioritize charting outreach.
Provider Education & CDI Support
Targeted education, feedback loops, and query programs to align provider documentation with coding and risk objectives.
Chart Retrieval & Data Acquisition
Secure, HIPAA-compliant chart retrieval across EMRs, specialists, and facilities to support reviews and audits.
Audit Support & Remediation
Preparation, response management, and remediation planning for internal and payer audits related to risk adjustment.
Reporting & Analytics
Interactive dashboards, RAF trend analysis, HCC capture heatmaps, and performance KPIs for stakeholders.
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Risk Adjustment Workflow
A repeatable, audit-ready workflow that ensures timely capture and accurate risk scoring at scale.
Identification
Claims and clinical triggers identify charts for review.
Chart Retrieval
Secure acquisition of medical records and supporting documentation.
Clinical Review
Nurse/clinician abstraction for HCC-relevant conditions.
Coding Validation
Coder verification and HCC validation mapped to coding rules.
Provider Query / Education
Structured queries and feedback to close documentation gaps.
RAF Modeling & Reporting
Quantify impact, update registries, and report to stakeholders.
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