Risk Adjustment FAQ: Operational Details for MA and HCC Teams

Use this FAQ when your risk adjustment, coding, analytics, and compliance teams are validating implementation fit after the product overview.

What data do you need to start?

Minimum inputs are encounter notes, problem lists, claims history, and member demographics. Optional boosts include labs, imaging, medications, and SDoH data. QuickIntell can start on a subset and improve as feeds expand.

What about physician engagement?

Provider scorecards and in-workflow queries minimize disruption. QuickIntell integrates with inboxes and EHR messaging where available so risk adjustment teams can close gaps quickly without creating a separate physician workflow.

How does this integrate with our clearinghouse and actuaries?

QuickIntell matches suspect and capture events to 837/835 activity and publishes governed datasets to Snowflake or BigQuery for actuarial analysis. Teams can reconcile accepted captures, submissions, acknowledgments, and downstream payment impact without rebuilding the model in spreadsheets.

Can you support multi-state, multi-plan compliance?

Yes. Environment-scoped rules support per-line-of-business configurations, release versioning, and audit logs for every policy change. Compliance teams can see which model, threshold, and reviewer decision applied to each patient and payment year.

What's included in onboarding?

Onboarding includes data mapping, ruleset tailoring, user training, and a 90-day success plan with RAF lift, documentation sufficiency, reviewer productivity, and submission-readiness targets.