Risk Adjustment Payments: Investigation of Discrepancies Tool (RAPID)
The best way to find EDGE data deficiencies.
There are two reasons we call this product RAPID: 1) It’s an acronym that stands for Risk Adjusted Payments: Investigation of Discrepancies Tool, and 2) fixing issues on the EDGE data server is a race against deadlines and priorities — a race that only RAPID analytics can help your organization win.
Using our exclusive RAPID tool, Wakely helps Affordable Care Act (ACA) carriers analyze their EDGE server submissions. By replicating the “black box” EDGE calculations, RAPID identifies fixable data errors that could significantly impact revenue.
Team up with Wakely for RAPID results.
Here’s how the RAPID process works:
- Your organization sends a complete set of EDGE files to Wakely for RAPID analysis (RAPID uses the standardized set of inbound and outbound EDGE XML files)
- Wakely uses the RAPID tool to review and analyze the data. A report of the results is returned to you in 3 to 6 business days
- The report focuses on metrics and analytics that have proven the most impactful over years of EDGE data review for our clients
- Our experts guide your team in identifying actionable insights from the results
Request a consultation to learn more about RAPID.
The most thorough examination of your EDGE data.
The Wakely RAPID tool allows us to give you results that are both timely and comprehensive. Here are some (but not all) of the tasks it accomplishes:
- Provides diagnostics and benchmarks based on millions of ACA lives
- Prioritizes rejected and orphaned medical and pharmacy claims that, if fixed, would add a new Hierarchical Condition Category (HCC) or additional high-cost risk pooling payment to a member, improving financial results
- Independently verifies CMS risk adjustment calculations at the member and condition level
- Identifies systematic EDGE issues by comparing key metrics to benchmarks
- Provides benchmarks for CMS qualitative outlier metrics
- Calculates the impact of supplemental submissions (i.e., impact on the risk transfer from add and/or delete codes) and lists ineffective supplemental encounters
- Identifies mother-infant bundled claims
- Flags diagnosis code truncations and provider coding patterns that may indicate errors
- Monitors telehealth claims and conditions related to risk adjustment
The RAPID timeline.
Supplemental add-on for advanced analytics.
For issuers with more advanced analytical needs, a supplemental add-on service for RAPID offers these additional benefits:
- Quantifies the financial impact of supplemental efforts (diagnosis code submission, home visits, etc.)
- Can isolate supplemental efforts to help provide an accurate calculation of each program’s impact on the final transfer amounts
To use this add-on, more in-depth data collection is usually necessary.
