Supports dozens of risk-bearing providers and Medicare Advantage, Affordable Care Act, and Managed Medicaid plans, delivering actionable insights on over ten million members.
Used by healthcare organizations and risk-bearing providers navigating complex regulatory risk adjustment and premium requirements.
Helps improve confidence in revenue forecasting and audit readiness.
Enables earlier identification of discrepancies, reducing downstream financial and compliance exposure.
Financial performance in government programs depends on a small number of critical factors working as intended. When risk adjustment and premium payments are misaligned or managed in isolation, plans face greater uncertainty, compliance risk, and operational strain.
Pareto RevenueIQ offers a structured approach to program administration through two dedicated solutions: RevenueIQ for Risk Adjustment and RevenueIQ for Premium Integrity. Together, they provide a complete and defensible view of your operations, grounded in documentation, transparency, and audit readiness.
Accurate clinical documentation ensures comprehensive and compliant member-health status is being reported for risk adjustment consideration. The risk adjustment solution improves your confidence in risk score integrity, so your team can better understand its impact on financials by identifying drivers, reducing potential exposure, and supporting audit readiness.
Key focus areas include:
A module exclusive for our Medicare Advantage plan clients, the premium integrity solution supports accurate enrollment data, both historically and ongoing, to achieve accurate premium revenue. It helps plans identify discrepancies early, collect historical underpayments, and ensure accurate premiums ongoing.
Key focus areas include:
Pareto RevenueIQ is designed for leaders responsible for financial integrity, compliance, and operational performance, including:
Pareto RevenueIQ goes beyond siloed point solutions. It organizes the two primary drivers of program integrity, risk adjustment and premium payment accuracy, within a shared intelligence framework. By focusing on the factors that drive compliant and accurate outcomes, RevenueIQ helps plans operate with greater accuracy, transparency, and confidence, supporting predictable performance and stronger audit readiness without adding operational complexity.
RevenueIQ concentrates on the factors with the greatest impact on member health statuses and premium drivers within an organization, ensuring compliant and comprehensive information is considered for improved accuracy.
Clear insight into member health status drivers supports stronger internal alignment, clearer communication with stakeholders, and more defensible outcomes during audits and reviews.
By improving accuracy, RevenueIQ helps organizations forecast with greater confidence and plan for what’s ahead.
Pareto’s approach reflects deep experience across government programs, regulatory requirements, and operational realities.
RevenueIQ improves accuracy and transparency into the driving factors that ultimately affect revenue streams–helping teams align around a cleaner, more defensible view of expected outcomes.
RevenueIQ configurations integrate into existing workflows and operational structures. Pareto works with teams to align data and priorities, supporting adoption without disrupting day-to-day operations.
RevenueIQ provides dedicated solutions that address the primary drivers of program integrity: member health status and payment accuracy. This allows your organization to operate with audit readiness built into ongoing operations rather than treated as a completely separate effort.
Success is reflected in improved accuracy, reduced variability, earlier issue identification, and greater confidence across finance, compliance, and operational teams.
By improving accuracy across risk adjustment and premium integrity, RevenueIQ helps you operate with a clearer understanding of expected financials and reduced volatility.
Clear insight into the drivers behind financial outcomes supports earlier issue identification and more proactive mitigation.
RevenueIQ supports defensible processes and documentation, helping you respond to audits and regulatory review with greater confidence.
Bring together insight across risk and premium adjustment to support a clearer view of revenue drivers.
Apply the 80/20 principle to surface the factors with the greatest impact revenue outcomes.
Track accuracy and discrepancies continuously to support earlier issue identification.
Align intelligence with real-world operational and compliance workflows.
Pareto RevenueIQ is a revenue intelligence solution that helps healthcare organizations, like government-sponsored health plans, improve accuracy, transparency, and confidence across risk adjustment and premium accuracy.
RevenueIQ brings these functions together under a unified intelligence framework, providing a more cohesive perspective of financial drivers and outcomes.
RevenueIQ focuses on accuracy, compliance, and transparency. Improved revenue performance is the outcome of getting those fundamentals right.
RevenueIQ is used by executive, finance, compliance, and operational leaders responsible for risk adjustment, revenue integrity, and overall program performance.
On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days
The use of analytics and insight to understand, monitor, and support accurate revenue outcomes across interconnected financial and operational drivers.
Processes that ensure a member’s health status is accurately assessed, addressed, captured, and shared with government entities for compliant reimbursement purposes.
Processes that validate eligibility and enrollment data to support accurate premium payments.
Pareto Intelligence delivers predictive insights and advisory expertise to help health plans and risk-bearing providers navigate complexity with clarity. As part of the Convey Family of Companies, Pareto pairs precision analytics with broader operational and technology capabilities to support stronger performance across the member journey.
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.
