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HEDIS Abstraction

Our HEDIS Abstraction services focus on timely and accurate chart abstraction to support Healthcare Effectiveness Data and Information Set (HEDIS) reporting, which is crucial for evaluating and improving payer quality metrics. Our experienced team carefully reviews patient charts to identify, extract, and code the necessary data points required for HEDIS measures, ensuring full compliance with reporting standards. By ensuring accurate abstraction, we help healthcare organizations and payers achieve higher quality scores, enhance patient care, and maximize reimbursement opportunities linked to value-based care initiatives. Our commitment to accuracy and efficiency not only supports NCQA (National Committee for Quality Assurance) guidelines but also enables providers to demonstrate their quality performance, reduce gaps in care, and improve overall health outcomes.

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ACA Commercial Risk Adjustment Coding

We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.

Frequently Asked Questions

1. What is HEDIS abstraction?

HEDIS abstraction is the process of reviewing and extracting patient chart data to support HEDIS reporting, which measures healthcare quality and performance.

2. Why is HEDIS reporting important for payers and providers?

It evaluates care quality, helps close care gaps, supports NCQA compliance, and impacts value-based care reimbursements.

3. How does Arovva Solution ensure accurate HEDIS abstraction?

Our experienced team conducts thorough chart reviews, extracts required data points, and codes them precisely to meet HEDIS and NCQA standards.

4. What benefits do organizations gain from HEDIS abstraction services?

Accurate abstraction improves quality scores, maximizes reimbursement opportunities, strengthens compliance, and enhances overall patient outcomes.