Case Study: Nation’s Largest Health Plans Provider achieves RADV audit readiness with GeBBS Healthcare Solutions

Nation’s Largest Health Plans Provider - Customer Case Study

Nation’s Largest Health Plans Provider, one of the nation’s largest health plans serving nearly 6 million members nationwide, including more than 1 million Medicare Advantage enrollees, needed to close gaps in data collection and documentation for risk adjustment. Before working with GeBBS Healthcare Solutions, incomplete HCC capture and faulty add/delete files submitted to CMS left the plan exposed to reimbursement and RADV audit risk.

GeBBS Healthcare Solutions implemented its iCode Risk Adjustment Workflow and performed first- and second-level chart reviews using certified coders. On a 500,000-chart sample, GeBBS validated 92% of first-level findings, identified 53,208 deletes and 114,985 additional HCCs, and increased average HCCs per member from 3.75 to 4.5. The multi-level review gave the plan more accurate risk scores, better audit readiness, and actionable provider feedback to improve future documentation.