Clair360™
Clair360™, an interactive, fully integrated, and AI-based platform with multi-module solutions, that identifies risk adjustment and quality issues and communicates in real time to all internal and external stakeholders how to resolve them. Clair360™ plugs into the existing IT infrastructure of Medicare Advantage plans, provider groups and hospital/health systems via APIs.
Clair360™, the artificial intelligence “glue” that binds Medicare Advantage, IPAs and Providers and hospital systems into a unified healthcare ecosystem.
Solutions to common problems with Risk adjustments
Cloud-Based, pay as you go system
End-to-end system integrates
Low/No capital Investment
Secure and Affordable Solution
API interfaces with most EHR/EMR systems
Scalable ML & AI Solution
Clair360™
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.
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.
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.
RAF360
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.
Quality360
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.
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
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.
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.
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.
