DCA Dynamic Commerce Applications

DCA has provided quality management and software services for over 18 years. DCA established in 1991 in Pennsylvania helps both Medicare and Medicaid plans to overcome the challenge of Risk Adjustment Payment that impacts their bottom line revenue and quality of patient care.

Improve Medicare/Medicaid Risk Scores and Revenue

DCA’s Risk Adjustment-Rate Platform (RAP), enables a plan to:
	Proactively & consistently monitor and improve its risk score and therefore revenue
	Identify those providers whose coding significantly impacts risk score and payment.
	Enable the targeted providers to submit complete diagnostic data (essential in risk scoring) on a consistent basis for both Prospective and Retrospective risk scores
	Identify and provide outreach to members who significantly impact the score for Prospective risk score improvement
	Use RAP risk-based data and analytics for disease / case management, provider profiling, provider contracting, P4P, provider payment, and medical underwriting
	Achieve the fastest, most practical, and most efficient outcome (consistently improving risk score) and ROI

Helping plans across the country improve their revenue by millions of dollars.

RAP-Medicare™

Supports Non-Drug, Drug and ESRD risk models, i.e. HCC, RxHCC, and ESRD. RAP-Medicare™ is for Medicare Advantage Organizations (MAO) including Medicare Advantage (MA) plans, MA-PD, and SNP.

RAP-Medicaid™

Supports risk various models such as CDPS, ACG, CRG, and MRX. RAP-Medicaid™ is for Medicaid Managed Care Organizations (MCO) including Medicaid MCO and Commercial/Medicaid MCO. RAP-Medicaid™ is customized for those states that risk adjust the payments.

Fundamental Concepts of RAP

Prospective Strategy:

	The most cost effective and quickest way to improve score
	The most gain in revenue comes from reporting the persistent conditions year over year. If a plan has consumed all the Prospective methods of improving score, then it may be cost-effective to pursue other approaches such as full medical record review. For this reason, RAP’s Prospective targeting and enabling features are designed for the highest outcome with the least possible cost
	Enable the targeted providers to submit complete diagnostic data (essential in risk scoring) on a consistent basis for both Prospective and Retrospective risk scores
	Only pursue a retrospective recovery when necessary since recovery is always more expensive and time consuming to implement while its outcome would be a small portion of the total potential improvement

Other Services

Risk Scoring Strategy:

Need help defining and/or managing its risk scoring strategy? DCA’s senior consultants would provide additional assistance in various areas such as: determining specific Provider/Member intervention strategy, identifying the type and number of in-house resources needed, conducting work sessions, and tuning the action plan on an on-going basis.

Risk Scoring Services:

Risk Scoring Services provide specialized and regular data feeds for disease / case management, provider profiling, provider contracting, P4P, and medical underwriting.

Encounter Reporting Services:

Encounter Reporting Infrastructure (ERI™). ERI™ is DCA’s full encounter reporting services that include Encounter processes such as: business operation, relationship management, establishing Encounter Centers, and technical processing of initial submission, reconciliation, adjustments, corrections, resubmissions.