Risk adjustment performance for Health Plans that need accuracy, controls, and audit-ready defensibility.
Prizm supports Health Plans with decision-grade analytics, operational controls, coding and documentation workflows, and RADV readiness practices built for real-world execution.
Where Health Plans typically get stuck
We focus on the issues that create revenue leakage, operational drag, and audit exposure.
Dashboards that don’t drive decisions
Reporting exists, but it doesn’t translate to action. Leaders can’t see what to fix next.
Inconsistent workflows and controls
Different teams follow different rules, creating rework and defensibility risk.
RADV exposure and documentation gaps
High uncertainty around support, retrieval, and evidence quality when it matters most.
How we support Health Plans
Compliance-first support that improves performance without breaking operations.
Decision-grade analytics and reporting
Executive-ready reporting that connects performance to actions, owners, and timelines.
- RAF drivers: recapture, suspecting support, provider segments
- Network visibility: where performance is drifting and why
- Operational KPIs: productivity, QA, throughput, cycle time
Program audit and remediation plan
A practical audit of your current MRA program and a remediation plan that leadership can execute.
- Workflow review: intake, review, QA, escalation, reporting
- Control assessment: consistency, evidence, and governance
- 90-day corrective action plan with priorities and owners
RADV readiness and defensibility support
Support practices that improve evidence quality and reduce last-minute scramble.
- Internal QA approach for documentation support and completeness
- Retrieval and tracking practices aligned to operational reality
- Leadership-ready audit readiness reporting and risk flags
Engagement options
Program audit (2 to 4 weeks)
- Rapid discovery and current-state assessment
- Findings summary and leadership-ready recommendations
- Prioritized remediation plan with owners and cadence
Ongoing support (retainer)
- Monthly analytics package and executive reporting
- Workflow reinforcement, QA guidance, and team enablement
- RADV readiness workstream support as needed
Built for defensibility
We design workflows with minimum necessary data practices and a “show your work” mindset so outputs remain clear, consistent, and defensible. If the engagement requires PHI, we recommend a Business Associate Agreement (BAA).
Want clarity fast?
Book a call and we’ll align on your current risk structure, biggest leakage points, and the fastest path to measurable improvement.
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