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Revenue & Quality Optimization

From uncovering risks to deploying intervention capabilities, SS&C Health offers a range of technologies and programs to optimize revenue and quality programs that enhance member care.

Customizable Solutions to Balance Revenue, Quality and Member Care Management

Balance the complexities and costs associated with administration, regulatory compliance, and member care management while providing the best care for your members.

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EDGE Server Submission Timeline

EDGE submission timeline details monthly activity to ensure compliance with CMS submission guidance and ensure successful risk adjustment submissions.


Risk Adjustment 365: Key Events and Milestones for Health Plans

Track progress with annual risk adjustment events and milestones divided by quarter, includes prospective and retrospective activity for each quarter.


Encounter Submission Services

Drive accurate government reimbursement for EDPS, RAPs, EDGE Server and Medicaid encounter submissions; user interface for real-time access to performance.

Revenue & Quality Optimization Solutions from SS&C Health

Our comprehensive solutions empower you to operationalize quality incentive and prescription discount programs, so you can track progress with quality along with budgets, spending and revenue impacts.

HCC Management A customizable, end-to-end solution combining analytics, artificial intelligence and services to provide transparency and collaborative support needed to control, manage and evaluate risk adjustment activities throughout the program. Includes comprehensive review and abstraction that screens and identifies HCC inaccuracies from claims data.

Encounter Submissions Complete, accurate and timely submission of encounter data derived from paid claim data or supplemental medical record reviews, to maintain government program compliance and ensure appropriate risk adjustment payments.

HEDIS and Star Ratings Analytics Industry-leading analytic capabilities to help effectively and accurately manage your HEDIS and CMS Star rating programs.

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Drug Discount Wrap Seamless access to competitive discounts on list prices when a prescription is not covered under a member benefit. You determine which drugs to include in the program, and retain your claims data for drug utilization review and utilization management edits/programs. In addition to improved pharmacy data capture and member satisfaction, our drug wrap program offers a unique revenue-sharing option.

Population Health Analytics Accurate and reliable metrics to power your population health stratification; available as a license or in a service model.

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