Shai Global Analytics
Value Based Services
Stay ahead in value-based care with SHAI’s smart solutions.
While you focus on patient care our solutions will help you stay ahead in value-based payment models.
Retrospective, Concurrent and Prospective Coding
We use various risk adjustment models, including CMS-HCC, HHS-HCC, Rx-HCC, and CDPS, to provide precise cost predictions. Our comprehensive approach ensures accurate coding and effective risk adjustment, benefiting both providers and payers. By leveraging these models, SHAI supports healthcare providers in optimizing reimbursements and improving patient care, while also helping payers manage risk and control costs efficiently.
Clinical Documentation Integrity
We address under-documentation issues by ensuring thorough and accurate clinical documentation. This approach supports healthcare providers in optimizing reimbursements and improving patient care, while also aiding payers in managing risk and controlling costs efficiently. By enhancing documentation accuracy, SHAI helps both providers and payers achieve better financial and operational outcomes. Our commitment to meticulous documentation reduces the likelihood of claim denials and enhances overall compliance with regulatory standards. This comprehensive strategy ultimately contributes to a more streamlined and effective revenue cycle management process.
Healthcare Effectiveness Data and Information Set
We perform complex HEDIS abstraction by reviewing services relevant to each HEDIS measure, including medical history, lab results, problem lists, and specialist consultations.
We follow the latest NCQA (National Committee on Quality Assurance) guidelines to ensure that all data is collected and reported accurately, helping health plans improve their compliance and streamline the NCQA submission process, boost their rankings while meeting submission deadlines.
Some Specialities of HEDIS include:
  • Medical Record Retrieval
  • Data Abstraction
  • Prospective Risk Adjustment
  • Retrospective Risk adjustment
Auditing as a service
SHAI has implemented audit as a service in value-based care by focusing on the accuracy of coding and documentation for Hierarchical Condition Categories (HCC). This process is essential for ensuring correct reimbursements and enhancing patient outcomes. By meticulously evaluating coding practices, SHAI helps healthcare providers accurately reflect patient risk, comply with regulations, and ultimately improve the quality of care delivered.

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