Health Plans & Payers
V28 risk validation, HEDIS hybrid season support, and FHIR-enabled interoperability for health plans navigating value-based care at scale.
Payer-Side Intelligence at Scale
Health plans need accurate risk scoring, compliant chart reviews, and HEDIS-ready data to optimize payments and meet regulatory mandates. Zenexa delivers it all.
V28 Risk Adjustment
Dual-model (V24/V28) HCC coding with automated condition mapping, ensuring accurate RAF scores during the CMS transition period.
HEDIS Hybrid Season
Chart chase, abstraction, and supplemental data collection for all HEDIS measures — delivering compliant submissions ahead of deadline.
FHIR Interoperability
FHIR R4-compliant data exchange, CMS Interoperability rule compliance, and seamless integration with provider EHR systems.
Retrospective Chart Review
Large-scale retrospective reviews to validate submitted diagnoses, identify coding gaps, and recover missed HCC opportunities.
RADV Audit Preparedness
Proactive RADV audit readiness with source documentation validation, coding accuracy QA, and audit defense support.
Stars & Quality Analytics
CMS Star Ratings improvement strategies, member outreach gap closure, and quality metric dashboards for MA plan leadership.
Results for Health Plans
Optimize Your Plan's Risk & Quality Strategy
Schedule a consultation to see how Zenexa drives RAF accuracy, HEDIS compliance, and Star Ratings performance.