How do we do it?

Sophisticated analytics and deep clinical understanding

Clinical Data Analysis

Step 1—Benchmark Analysis

We begin with a benchmark and your paid claims. We run the provided claim file through our analytics. We determine the variance in pertinent diagnoses and HCC values between your declared HCCs, by member, and what we have identified.

Step 2—Opportunity Report

We prepare an opportunity report to highlight our findings, by HCC, with potential revenue. We also quantify the tactical aspects of a physical audit and auditing staff required.

Targeted Auditing

Step 3—Audit Launch

Based on your Opportunity Report, we detail the audit requirements, assign a Cognisight Account Manager, and begin the engagement.

Step 4—Results and Performance Monitoring

You receive access to a secure web site where audit progress is available on demand, so you can monitor the results and performance at any time with a click of a button.

Submitting and Summarizing

Step 5—RAPS Format Conversion

We continuously prepare RAPS-ready files, based on your auditor results, and transmit them to you according to the schedule you prefer. Each transmission is accompanied by a summary report of content and a reconciliation summary.

Step 6—Reconciliation Forecast

At the end of the audit, we provide you with a reconciliation forecast that will detail the starting point, what was submitted and accepted—sorted by member—and the expected reimbursement return.

Step 7—Audit Review and Recovery

We quantify the audit results and determine outstanding documentation for CMS reimbursement, and then can begin phase two recovery efforts.

Improving Care, Increasing Revenue

Step 8—Quality Care Support

We work with you to generate information to support your disease management, quality and case management efforts. The data collected during the audit provides a pinpoint view into your membership. Specific detail on member conditions and physician behaviors helps focus your interventions.

Step 9—Reimbursement

We don’t get paid until you get paid. There’s no risk. It’s that simple.

We're there for you, every step of the way.