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RISK SCORE ACCURACY SOFTWARE

Converged Risk

Take charge of your risk adjustment program and leave audit worries in the rear-view mirror.

Reliable Risk Score Accuracy Software

As risk adjustment programs face increasing regulatory and audit pressures, health plans need a tool to keep up with these ever-changing demands. Inovalon’s Converged Risk™ is a scalable, complete risk score accuracy software tailored to your unique program needs.

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Reduce Your Audit Risk

Protect your health plan from costly penalties by catching and removing over-coded conditions before they become an issue.

Improve Risk Score Accuracy

Uncover hidden gaps and ensure full reimbursement for your members’ risk burden with complete visibility into every step of the process.

Control Chronic Conditions

Ensure members with chronic conditions get the care they need to stay healthy, improving their outcomes and your plan’s performance.

Benefits

Take the guesswork out of your risk adjustment program with analytics trained by machine learning that help catch coding errors. Gain clarity and identify incomplete or improperly reflected member diagnoses in your claims data systems and abstracted medical records.

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Improve Reporting and Documentation

Use HCC surveillance analytics to identify potentially over-coded conditions with associated clinical evidence.

Data-Driven Intervention Planning and Execution

Implement proven education and multi-channel intervention strategies to support comprehensive patient assessment and accurate documentation.

Predictive Analytics Insights

Create your own cohorts and run predictive gap identification and intervention planning analytics on demand.

Compliant, Accurate Regulatory Submissions

Proactively manage claims processing at various stages throughout the submissions process and monitor the financial impact of claims.

3-8%

Risk factor impact¹

3

Additional gaps addressed on average²

HOW IT WORKS

Accurate Analytics. Better Member Experiences.

Reducing audit risk or uncovering all the gaps in your member population’s risk burden is nearly impossible without full control and visibility over your risk adjustment targeting. Traditional tools leave you guessing where to focus your efforts, which can cost your health plan time, resources, and reimbursement.

With Converged Risk, the only risk score accuracy software designed to give you control of the dials over your entire risk program, so you can efficiently uncover more gaps and ensure your population’s risk burden is accurately reflected.

Use this software to:
• Mitigate audit risk with confidence
• Capture accurate reimbursements for your member population’s true risk
• Deliver better care for your members while improving overall health outcomes

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TESTIMONIALS

Top-Notch Customer Service

Real-life users share what you can expect to have Inovalon in your corner.

“

Inovalon listened to us, and they knew what we needed. They heard our requirements and they made sure that they met them and made sure that we were happy and getting what we asked for.
Brenda WolfordBusiness Analyst, Geisinger Health Plan

Related Products

Ensure compliance with analytics solutions that complement our risk score accuracy software. Improve documentation, operational efficiency, and member conditions.

Converged Outreach

See all your intervention activities and vendors together in one place, to make sure members get the right interaction at the right time.

Converged Quality

Quality measurement software that empowers your team to feel confident and in control of their quality ratings.

Converged Patient Assessment

Help provider partners improve your health plan's risk score accuracy without disrupting their day job, with this point-of-care solution for clinical documentation.

Converged Record Review

Empower your medical record reviewers to work faster, smarter, and ensure your plan is reimbursed accurately.

Converged Risk Surveillance Analytics

Gain a better line of sight into your risk adjustment programs and stay audit ready as the regulatory landscape changes.

Converged Submissions

Eliminate the headache from the last mile of risk adjustment data and encounter submissions, and deliver complete, accurate, and secure submissions - on time.

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¹ Based on the average risk factor impact calculated based on intervention execution by Inovalon. Results will vary based on effective execution of your organization’s intervention program using Converged Risk output, May 2025
² Based on Inovalon’s analysis of gap closure improvements driven by a combination of Converged Risk, Converged Quality, and Converged Outreach, May 2025
³ Based on Inovalon’s analysis of Converged data analytics processing speeds compared to the industry average, October 2024.