Payer Solutions Risk Adjustment Solutions to Give You
Control Over Your Business Strategy

Description

Payer Solutions

Talix offers payers a revolutionary strategy to assert much more control and effectiveness over Risk Adjustment programs.  Our suite of workflow applications provide options to optimize revenue and resources regardless of whether you outsource certain functions such as chart reviews or maintain everything in-house.

Talix serves many Blue Cross / Blue Shield plans, national carriers, provider-owned Health Plans, and regional plans focused on Medicaid, ACOs, and/or Medicare Advantage.

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Application Suite for Payers

Coding InSight

The Coding InSight workflow application combines our proprietary, healthcare NLP, machine learning, and an extensive health taxonomy to streamline the labor-intensive retrospective chart review process. Coding InSight quickly uncovers missed codes and documentation gaps in member data so coders can process higher chart volumes with increased accuracy and efficiency. 

With Coding InSight, you can proactively identify high-risk patients, capture miscoded or un-coded diagnoses in patient charts, and quickly close those gaps.

Unstructured data is often the challenge and typically data like free-text care plans, historical chart notes, and specialist reports. This is where valuable information about the patient’s diagnosed conditions and treatment plans is often buried. By mining this untapped data, you get the most accurate view of patient risk for improved care planning. 

Find out how Coding InSight can help you successfully manage patient risk through improved risk scores, optimized reimbursements, and better patient outcomes.

 

Claims InSight

In today’s complex and heavily regulated environment, health plans must be prepared for increased scrutiny of their HCC and HHS submissions to CMS. Manual retrospective chart reviews are error-prone and costly—particularly for payer organizations that rely on third-parties for a second (2LR) and third pass (3LR) reviews. Talix’s Claims InSight streamlines the code validation process so health plans can gain more control of their Risk Adjustment initiatives, improve coder productivity and ensure accurate code submissions.

Find out how Claims InSight can help you validate accurate claims for submission and boost your compliance with future audits. 

Use Coding InSight & Claims InSight Together

With Coding and Claims InSight combined, you can employ one unified workflow to add and delete HCC codes according to your guidelines.  

Find out how the combination of Coding and Claims InSight can help you produce accurate claims for submission and boost your compliance with future audits in one workflow.

Virtual Coder

Talix partners with the world’s finest staff coding organizations, both on-shore and off-shore.  The Virtual Coder is highly proficient on the Talix coding applications and enabling NLP and machine learning technologies.  This service delivers highly accurate results whether your strategy is first pass, second pass, claims validation, or member suspecting.  Find out how the Virtual Coder in combination with the Talix coding platform can address campaigns at any volume and deliver a remarkable ROI.

Suspecting InSight - Coming Soon

Suspecting InSight’s automated analytics system identifies members with missed codes, potentially undocumented conditions, or documentation gaps to help identify members with missing or incomplete conditions. The Talix system evaluates huge volumes of data to help overcome missed members and conditions. Find out how Suspecting InSight can help you identify patients with the most HCC opportunity and refine your chart chasing strategies. 

 

e-Retrieval

Access to patient charts through expensive manual processes has become even more challenging.  Talix has solutions, whether it’s enabling patient chart look-ups or integrating electronic patient records into the payer environment.   Payer-provider collaboration over the sharing of financial risk is also leading toward the sharing of electronic patient data as well.  Please contact us for more information on the solutions we offer.

Powerful Features

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Comprehensive Coding Workflow

Increase productivity and accuracy with claims validation and code reconciliation in a single, easy-to-use workspace. Highly configurable workflow to support varying coding and QA workflow processes

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NLP Powered Risk Stratification

Identify and prioritize members and charts with the most missed codes and documentation gaps detected by our powerful NLP engine that helps maximize your return on investment (ROI).

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Amazing Analytics and Reporting

Gain real-time understanding of coding progresses, productivity, and performance to better manage the impact from risk adjustment, boost Risk Adjustment Data Validation (RADV) compliance confidence, and improve provider education. Coding InSight enables administrators to track coder productivity and financial impact from risk adjustment as well as track provider coding patterns for improved provider engagement and Clinical Document Improvement (CDI) initiatives. Pre-built modules include:

  • Provider education analytics
  • Productivity analytics
  • Line of business analytics
  • Quality Assurance
  • Project performance
Unified

Unified Coder Workspace

Talix’s is the most efficient, easy-to-use, and powerful workflow on the market. Coders view clinical and financial member data in a single powerful workspace to quickly and accurately reconcile codes.

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Model Customer Success

We don’t implement your solution and then hide.  Our customers receive a robust offering of services to ensure your new strategies are supremely successful. We leverage state of the art tools and techniques to give you the comfort and confidence that you will achieve your goals.

The Results

In-house, outsourced or a combination of both (hybrid), Talix solutions provide flexibility and transparency into your coding operations to ensure accuracy, efficiency, and complete claims.

Claims Insight

The results are what matter most.  By leveraging advanced technologies and analytics coupled with world-class workflow designs, our customers see astonishing results.

RAF Scores
ROI

Close gaps.

Improve care.

Save time.

Smile more.

Second Level Review

Machine learning technology and advanced natural language processing can detect and extract HCC codes that were missed or miscoded during first-level reviews. Missed codes identified on a second-level review can result in millions of dollars in additional reimbursement for health plans while improving RAF score accuracy. Talix can set up a 2LR campaign in less than ten days, and immediately start to process thousands of patient charts per day. Try Talix for a Second Level Review.

 

Markets We Serve

Medicare Advantage ACA Commercial

Medicare ACO Medicaid