Clair360 an affordable solution to accurately calculate the risk adjustment factor and identify quality gaps

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Clair360™

An Interactive, fully integrated, AI-Based solution for accurately identifying RAF score and providing real time actionable insights on quality gaps. The tool empowers the stakeholders to not just identify the gaps but to track the progress and close these gaps. Clair360™, the artificial intelligence “glue” that binds Medicare Advantage, IPAs and Providers and hospital systems into a unified healthcare ecosystem.

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Risk Adjustment

The heart of the Risk Adjustment program is the RAF360. The focus is on membership RAF: Defining the current RAF, past RAF, future RAF – what it will be, and what it should be. Our goal is to identify all gaps and predict possible gaps to capture by using complex and validated analytical models.

Guaranteed at least 2x ROI within 12 months of Implementation
Closing gaps in Clinical conditions (Increasing RAF)
20% decrease in cost in risk management programs
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Improve Quality Score

This module identifies the current quality measures status, identifies the gaps, and provides possible ways to close them which will help improving quality performance metrics. Self-Managed AI-based module that allows you to update your measures status as frequently as needed.

Increased Quality Stars Ratings
Reduce CMS Audit Risks
Hundreds of thousand savings in the technology costs
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Other 7 Additional Modules makes Healthcare easy for you!

The healthcare industry is made easier with the our seven additional modules, namely Member360, Coding360, Provider360, Claims360, Payment360, Submission360, and Tasks360. These modules aid Medicare Advantage, IPAs, providers, and hospital systems in their operations.

Some of the features of these modules include a member-centric approach that provides a comprehensive view of the members, automated NLP-based charts, enhanced quality, completeness, and efficiency of services for patients, the ability to analyze complex claims data for cost and utilization statistics, and a fully integrated task management module for managing, communicating, tracking, and reporting all projects and tasks.

This member-centric module provides 360° insight about your members. It compares current demographic and health status to historical statuses and predicts future status. This results in better membership management by closing gaps in the member’s healthcare and quality measures.

Member360

This member-centric module provides 360° insight about your members. It compares current demographic and health status to historical statuses and predicts future status. This results in better membership management by closing gaps in the member’s healthcare and quality measures.
This module includes a clinical coding tool that has automated NLP-based charts and data review processes which allows organizations to capture various data like diagnosis codes, procedure codes, quality measures, and much more.

Coding360

This module includes a clinical coding tool that has automated NLP-based charts and data review processes which allows organizations to capture various data like diagnosis codes, procedure codes, quality measures, and much more.
This module focuses on providers to measure and enhance the quality, completeness, and efficiency of the services provided to the patients. It provides in-depth statistics and analytics to highlight any provider’s gaps and issues and how to resolve it.

Provider360

This module focuses on providers to measure and enhance the quality, completeness, and efficiency of the services provided to the patients. It provides in-depth statistics and analytics to highlight any provider’s gaps and issues and how to resolve it.
This module provides a 360° view of claims. It allows users to slice and dice the complex claims data to provide answers to business questions like utilization, costs, and statistics easily. In addition, it utilizes claims data to get an accurate PMPM and to identify possible ways to reduce it.

Claims360

This module provides a 360° view of claims. It allows users to slice and dice the complex claims data to provide answers to business questions like utilization, costs, and statistics easily. In addition, it utilizes claims data to get an accurate PMPM and to identify possible ways to reduce it.
This module focuses on cash flow and the RA payment models and processes to help organizations identify what likely payment when they should receive payment, and identify any gaps in payments.

Payment360

This module focuses on cash flow and the RA payment models and processes to help organizations identify what likely payment when they should receive payment, and identify any gaps in payments.
This module provides a complete picture of submissions. It reconciles what has been submitted with what should have been submitted. Also, it finds the gaps, rejections, and other issues in the submission process then it creates files to submit missing data.

Submission360

This module provides a complete picture of submissions. It reconciles what has been submitted with what should have been submitted. Also, it finds the gaps, rejections, and other issues in the submission process then it creates files to submit missing data.
This built in fully integrated task management module enhanced managing, communication, tracking and reporting all projects and tasks related to programs and process within the Clair360™. It provides an easy and interactive way to create, assign and track tasks to team members and providers.

Tasks360

This built in fully integrated task management module enhanced managing, communication, tracking and reporting all projects and tasks related to programs and process within the Clair360™. It provides an easy and interactive way to create, assign and track tasks to team members and providers.
Why Clair360™
Simple, Effective, and Powerful
Simple, Effective, and Powerful
Secure and Complaint
Secure and Complaint
Affordable and Reliable
Affordable and Reliable
Future ready, AI and Cloud enabled
Future ready, AI and Cloud enabled
Easy to Plugs into the existing IT infrastructure of
Payers (MA, ACA, Medicaid)
Payers (MA, ACA, Medicaid)
Independent Provider Associations
Independent Provider Associations
Hospital/Health Systems
Hospital/Health Systems
Clair360™ Ecosystem
How it Works

ROI calculator for Clair360™

Indirect Returns
30% Reduction in Manual work
20-25% decrease in running programs and In-home Visits
Yearly USD$500k savings on technology, infrastructure and resources
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