Clinical Risk Adjustment

Using Licensed Nurse Practitioners, SCCP performs clinical adjustment services aimed at ensuring that the health conditions and health status of health plan members are accurately documented, and that health plans are properly compensated for managing the care of its members.

Our Clinical Risk Adjustment Services include:

• • High level engagement for difficult-to-engage members.
  • Completing an accurate and substantiated clinical profile of members.
    • Verifying prior clinical diagnosis.
    • Assessing for worsening conditions.
    • Assessing for new, undiagnosed conditions.
    • Performing a review of all medications.
    • Ordering labs and diagnostic tests where necessary to confirm diagnosis.
    • Coding to clinical specificity.
    • Making referrals to primary care providers where member health conditions warrant it.