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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 coding, and secure defensible RAF.

Concurrent Review Prospective Review Retrospective Review HCC Validation RAF Modeling Audit Support

Full-Service Delivery

Concurrent Risk Review

Real-time chart review during inpatient and outpatient episodes to capture undocumented or under-documented diagnoses before claims are finalised.

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 Optimisation & Modeling

Data-driven RAF modeling and scenario planning to quantify impact, forecast revenue, and prioritise 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.

A Structured Workflow

01

Trigger Identification

Claims and clinical triggers identify charts for review.

02

Chart Acquisition

Secure acquisition of medical records and supporting documentation.

03

Clinical Review

Nurse/clinician abstraction for HCC-relevant conditions.

04

Coder Validation

Coder verification and HCC validation mapped to coding rules.

05

Provider Queries

Structured queries and feedback to close documentation gaps.

06

Reporting

Quantify impact, update registries, and report to stakeholders.

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