Deployed to over 40 healthcare organizations serving over 10 million members across Medicare Advantage, ACA Exchange, and Medicaid markets.
Informs compliant strategies across all critical organizational risk adjustment campaigns; concurrent, prospective, and retrospective.
Identifies opportunistic areas for in-year enhancements across the risk adjustment ecosystem through qualitative and quantitative evaluations; including over $250 million in encounter data integrity improvements achieved.
We help health plans and providers identify, prioritize, and address risk gaps through intelligent analytics and targeted interventions, compliantly impacting risk scores across Medicare Advantage, PACE, ACA, and Medicaid lines of business.
By combining these advanced analytics with expert support, Pareto RevenueIQ for Risk Adjustment helps evolve and deploy informed and strategic risk adjustment program management. Whether it's potential condition gaps or flawed encounter submissions, Pareto pinpoints what matters, and helps you resolve it with clarity and confidence.
Our risk adjustment solution supports Medicare Advantage, Medicaid, and ACA leaders seeking to improve risk score accuracy, identify, close and/or address condition gaps, and reduce audit exposure.
Inform revenue contributors through ROI-proven analytics and forecasting.
Identify potential audit-worthy conditions for further investigation in alignment with organizational strategies.
Align risk adjustment with Stars, CAHPS, and quality strategies.
Target the right members, with the right outreach, at the right time.
Organizations in regulated markets like Medicare Advantage, ACA, PACE, and Medicaid are under more scrutiny than ever, but most still rely on disconnected tools and reactive tactics to manage risk score accuracy. Pareto offers a more strategic approach, designed for accuracy, transparency, and return on investment.
Pareto identifies and informs which suspects matter, quantifies financial opportunity, and guides efficient closure strategies—so you can focus on what actually drives risk adjustment program performance.
We don't just track risk—we help you prove it. Every data point is tied to a source, encounter, and action history, giving your team strategic insights to prioritize RADV or OIG investigations.
Our client advisors have years of real-world experience and work alongside your team to interpret results, troubleshoot issues, devise actionable strategies and improve outcomes.
We use predictive analytics to identify potentially undocumented conditions and submission gaps, then help you prioritize closure efforts based on overall impacts to your risk adjustment program.
RevenueIQ combines advanced analytics, advisory expertise, and curated member-level risk adjustment data in one integrated solution. As a client, you not only receive insights and guidance but also transparent member-level data you can use for internal investigation, validation, and ongoing performance improvement.
RevenueIQ pairs advanced analytics with hands-on advisory support from professionals who have led risk adjustment, coding, and program operations within healthcare organizations. Clients gain both the technology to identify opportunities and the experienced guidance needed to interpret results, prioritize actions, and navigate real-world risk adjustment challenges.
Unlike black-box vendors, Pareto makes risk adjustment actionable, transparent, and aligned to your operations. Our platform drives better decisions by ingesting, normalizing, scoring, and returning actionable intelligence to the organization.
Clinical, claims, supplemental, government data sources, and SDoH data are aggregated and normalized into one analyzable environment.
Machine learning and healthcare-specific algorithms identify risk capture patterns in Medicare, PACE, ACA, and Medicaid populations by member, provider, and program.
Errors and inefficiencies are clustered based on financial and program impact—so you solve the right problems first.
Internal teams have access to member-level details, reports, evidence, and strategies they need to investigate potential issues efficiently and effectively.
CMS’s primary system for receiving risk adjustment data from Medicare Advantage plans and PACE.
Claim/encounter-level submissions with diagnosis, procedure, provider, and enrollment details, used for payment (risk adjustment transfers) and program oversight for Affordable Care Act plans.
A CMS-defined group of diagnoses that maps to Risk Score Coefficients for risk adjustment.
A CMS audit program that verifies the accuracy of submitted diagnosis data and payment.
In Medicare Advantage and PACE, a score assigned to each member based on diagnostic and demographic factors, used to calculate risk adjustment payments.
For the Health Insurance Exchange, a risk score that measures a plan's liability risk based on its enrollees' health status
Non-clinical factors (e.g., housing, income, transportation) that affect member health and plan risk.
Pareto Intelligence is a healthcare analytics and technology company that helps health plans and providers in government-sponsored markets improve financial performance and regulatory compliance. Our platform delivers actionable insights across premium reconciliation, risk adjustment, Stars, and member engagement—so plans can recover revenue, close gaps, and continually monitor program performance.
With solutions like RevenueIQ for Risk Adjustment, Pareto enables Medicare Advantage, ACA, and Medicaid organizations to identify risk coding gaps, quantify encounter data issues, and proactively reduce audit risk. Trusted by 75% of the nation’s largest health insurers, Pareto combines predictive analytics and expert guidance to turn fragmented data into measurable results.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
