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Retrospective Risk Adjustment Solutions

Health plans, providers and patients can feel the weight of risk adjustment programs due to inefficient, burdensome processes.


Comprehensive, efficient retrospective risk adjustment program

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How wasteful is your retro risk program?

For health plans subject to performing risk adjustment, their retrospective risk adjustment process may be costly, inefficient and wasteful in many ways:

  • Wasted resources and expense when managing multiple vendors
  • Unnecessary provider abrasion caused by retrieving unproductive charts
  • Disrupting providers with manual chart retrieval and review
  • Manual coding can miss potential unreported diagnosis codes and leave coding accuracy incomplete

The key to efficient chart review is minimizing disruption to the provider workflow to increase participation and enhance long-term relationships.

Managing risk with diverse and deep expertise

Optum uses its diverse and deep expertise to transform the chart review process. Optum artificial  intelligence (AI) modernizes the process by shifting the focus from volume of charts targeted to precision targeting of charts.

AI-enabled components of the Optum comprehensive retrospective risk adjustment solution enable a smart, highly efficient retrospective chart review process.

Improve accuracy and completeness with one vendor

Improve efficiency, reduce expense and maximize accuracy and completeness — all from one vendor. As a full-service retrospective risk adjustment vendor, Optum can take all your data and:

  • Run AI-enhanced analytics
  • Retrieve charts (digital or analog)
  • Review charts
  • Submit to HHS or CMS on your behalf
  • Help with HHS claims verification or throughout a CMS RADV audit

Explore our solutions

AI-Enabled risk adjustment solution

How smart is your retrospective risk adjustment solution?

Audit Services

How much support do you get during an audit?

Submission Services

We provide end-to-end management of submissions, direct errors and remediation. Insights promote continual improvement to maximize accuracy.