Our Solutions - Scope - Risk Adjustment Payment Integrity
The Risk Adjustment Payment Integrity Command Center for PACE Programs. Navigate complex CMS data flows, reconcile risk adjustment payments, ensure payment accuracy, and protect against audits. Scope automates the heavy lift of processing all 70+ CMS files, giving you complete visibility into your risk adjustment revenue, without the manual spreadsheet fatigue.
The Challenge - Risk Adjustment Is Broken
PACE programs and Medicare Advantage organizations face an impossible operational burden. With 70+ CMS files, siloed data systems, multiple vendors, and scarce expertise, most organizations settle for analyzing only a subset of their data, unknowingly leaving millions in revenue on the table.
Too Many Files, Not Enough Time
Processing all 70+ CMS files requires specialized expertise and significant operational lift. Most programs analyze only what they can manage, missing critical revenue opportunities.
Siloed Data, No Accountability
Data from RAPS, EDS, MARx, state government systems, and multiple vendors exists in isolation. Without a unified view, errors go undetected and revenue slips through the cracks.
Expertise Gap
Finding professionals who understand CMS data flows, risk adjustment rules, and payment reconciliation is increasingly difficult. The knowledge gap leads to missed opportunities.
Key Features - Complete Visibility. Full Control.
Scope eliminates the trade-off between operational capacity and data coverage. Our AI-driven platform automates the heavy lift, creating a transparent risk adjustment financial picture from 100% of your data, without the manual spreadsheet fatigue.
- Reconciliation Engine that ingests, processes, and integrates data across RAPS, EDS, and MARx without losing context
- Real-time tracking of files, membership, and payments with automated reconciliation
- Predictive modeling to forecast payment variances and identify issues before they become problems
- Error detection that identifies and helps resolve discrepancies early in the process
AI-Powered Intelligence - Ask Questions. Get Answers.
Our proprietary AI engine is trained exclusively on vetted healthcare knowledge. Ask any question about your risk adjustment data and get immediate, accurate insights. No more hunting through spreadsheets or waiting for analyst reports.
Example Questions
- "How many members did CMS payments come in for each month, and for how much?"
- "Which diagnoses were rejected in our EDS submissions last quarter?"
- "What's our expected vs. actual payment variance by payment month?"
- "Show me members with eligibility changes that affect their risk scores."
Unified Data View
Scope brings together data from all your sources into one coherent picture:
- CMS Systems (RAPS, EDS, MARx)
- State Government Data
- Risk Adjustment Vendors
- Internal Claims & Enrollment
Proven Outcomes - Maximize Revenue. Minimize Risk.
Organizations using Scope see measurable improvements in revenue recovery, data completeness, and audit readiness. Our platform ensures your risk adjustment payments are Fair, Accurate, Complete, and Timely.
$80 - $160
PMPM Revenue Recovery
100%
File Coverage (All 70+ Files)
Minimal
Audit Risk
Data Integration - Comprehensive CMS File Support
Scope processes the full spectrum of CMS data files, from claims submissions to payment reconciliation reports. No more settling for partial analysis.
- X12 837
- MAO-002
- RAPS Return
- MAO-004
- MOFs
- DTRRD
- FEFD
- MCMD
- LISPRMD
- PPR
- MMR
- MARx Files
Benefits - Why Choose Scope
Scope gives you complete control over eligibility, risk adjustment vendor management, data integrity, and payments, all in one platform designed for PACE and MA operations.
End the Spreadsheet Fatigue
Stop manually reconciling data across dozens of files and systems. Scope automates the heavy lift so your team can focus on decisions, not data wrangling.
Full Accountability
With all data in one place, you finally have visibility into vendor performance, submission accuracy, and payment integrity. No more finger-pointing when issues arise.
Audit-Ready Documentation
Maintain robust documentation and error tracking that protects you during RADV audits. Every reconciliation, every correction, every decision: fully documented.
Pricing - Tailored to Your Organization
Scope pricing is customized based on your organization's size, member count, and specific needs. Contact us for a personalized quote and demo.
Enterprise Solution
Get comprehensive risk adjustment payment integrity capabilities tailored to your PACE program or MA organization.
- Full 70+ CMS file processing
- AI-powered reconciliation engine
- Real-time payment tracking
- Concierge-level support
- Continuous updates and improvements
Ready to put an AI co-analyst to work for your team? Let's talk.
Our offices
- Palo Alto, CA
Corporate HQ - Atlanta, GA
Technology Branch