Risk Model Validation and Insight Delivery

Supported risk models and coding gap insight delivery.

The system provides robust support for four distinct risk adjustment models to ensure comprehensive clinical data coverage:

• Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS HCC) (version 28)
• Health and Human Services (HHS) HCC (version 7)
• End-Stage Renal Disease (ESRD) (version 24)
• Chronic Illness and Disability Payment System (CDPS) (version 7.2)

Each identified risk category is validated by Oracle to ensure that it aligns with Oracle-supported content. Following successful validation, these matched categories are automatically queued in Diagnosis Insights. Presented as suspect or inferred conditions, these insights allow providers to efficiently review and act on potential diagnoses directly in their clinical workflow.