Risk Adjustment Solutions to Give You Control Over Your Business Strategy
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.
Application Suite for Payers
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.
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.
Note: 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.
As the first comprehensive solution that integrates chart retrieval, coding, and claims validation workflows into one single platform, Talix’s Chart InSight aims to solve the industry’s various interoperability challenges by streamlining both manual and eRetrieval while synchronizing internal team and vendor efforts. Chart InSight gives payers the ability to automate retrieval workflows for both manual and electronic retrieval, monitor campaign progress, and evaluate provider and vendor performance through the platform. Chart InSight’s seamless integration with Coding InSight provides the transparency needed to save valuable time and resources while also enabling an efficient feedback loop.
Chart InSight’s seamless integration with Coding InSight provides the transparency needed to enable a quick feedback loop, speed up the overall retrieval and coding process and save valuable time and resources for your organization.
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.
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
Talix 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.
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).
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
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.
- Close Gaps
- Improve Care
- Save Time
- Smile More
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.
The results are what matter most. By leveraging advanced technologies and analytics coupled with world-class workflow designs, our customers see astonishing results.