Points of Light 2023 Case Study 3
13 April 23
| Aurene Wilford and Boyd Stewart
To meet CMS requirements for the submission of risk adjustment data and ensure they are being fully reimbursed by CMS, payer organizations need increasingly specific coding information, and these requests for information can put undo administrative burdens on provider organizations. Seeking to increase the payer organization’s access to needed information without increasing the provider organization’s workload, the collaborators in this case study established an API that enables an automated, standardized retrieval process for records that the payer organization needs in order to complete managed care audits.