Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)
Keep EDGE data accurate with help from RADIAL.
Affordable Care Act (ACA) claims and enrollment data take quite a journey before being finalized in the EDGE server. Along the way, discrepancies and data leakage can occur between different data sources and stops — and that can result in inaccurate risk adjustment and reimbursement.
Using the Risk Adjustment Data Integrity: Analysis & Lineage (RADIAL) tool, Wakely compares multiple data sources to provide transparency in risk score differences between sources. Our comprehensive analytics allow your organization to pinpoint which encounters are driving discrepancies.
The road to data integrity with Wakely and RADIAL.
Here’s how the RADIAL process works:
- Wakely uses the RADIAL tool to thoroughly examine your EDGE and flat file encounter inputs
- The tool prioritizes members based on differences and produces drill-through analytics to identify encounters driving discrepancies between data sources
- The results are delivered to you within 2 to 3 weeks, and include a summary report in Microsoft Excel as well as encounter-level detail in text files
Request a consultation to learn more about RADIAL.
The RADIAL results: Your map to accurate risk adjustment.
Wakely provides a comprehensive report of RADIAL results to guide your EDGE submissions, including:
Summary Report
- Risk score summaries by Health Insurance Oversight System (HIOS) ID, market, rating area, and plan identifier
- Top member differences between scenarios
- Hierarchical Condition Category (HCC) count differences between scenarios
- Top prioritized claims that result in a different HCC between scenarios
Encounter-Level Detail
- Member-level risk score files with condition markers for each scenario
- Member-level risk score differences between scenarios
- Claim-level information with markers
Our recommended RADIAL schedule.
Wakely offers RADIAL on a fixed-fee or per-run schedule. The suggested run schedule is:
- Run 1: November/December
- Run 2: January/February
- Run 3: March
