Driven by Data.
Inspired by Outcomes.

Driven by Data.
Inspired by Outcomes.

About

By partnering with Tessellate, you will benefit from industry-leading solutions that deliver proven results. Our risk adjustment and quality programs bring together every piece of the puzzle to improve revenue integrity and improve quality of care. We offer end-to-end solutions that are provider-centric, low abrasion and can be quickly implemented. Tessellate’s experience working with Medicare Advantage and Commercial plans, driving effective provider engagement, and supporting strategic initiatives in risk adjustment and quality will provide solutions that achieve your goals and deliver value beyond the numbers.

The average health plan likely documents and reports less than 60 percent of the chronic conditions of its members. Tessellate improves risk score accuracy and simultaneously reduces RADV audit risk while boosting Star Ratings.

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Solutions

Tessellate brings you the most innovative and versatile solutions in the industry. You can increase the compliance and completeness of clinical condition documentation, improve risk score accuracy and drive quality improvement for Stars with help from Tessellate.

  • Serves over 1 million Medicare Advantage and Commercial members
  • Operates in over 20 states and Puerto Rico
  • Manages over $5 billion in risk adjustment-related revenue
  • Delivers over $300 million in quality-related bonus revenue
  • Has achieved a 4-Star Rating for a national PPO plan the past four years

Provider Engagement Coordination

A differentiated prospective program. Between our on-site Provider Engagement Coordinators (PECs) and our proprietary process, this program focuses on assisting providers with complete and accurate documentation with minimal abrasion.

  • Provider-centric prospective program
  • Improves risk score accuracy
  • Improves clinical Star measures
  • 1- to 3-month implementation timeline
  • In-market resources
  • Technology enablement

Risk Adjustment

A true end-to-end risk adjustment solution. Our program has unique comprehensive capabilities and a fully integrated approach. While most efficient as a combined package, all risk adjustment solutions are available as point solutions. We dive deep into member profiles, provider performance and condition-specific analysis to deliver superior outcomes. The solution includes:

  • CMS bid optimization and benefit design
  • Projections, modeling and reporting
  • Retrospective services
  • RAPS/EDPS data submissions
  • RADV audit support

Quality Improvement

A partner with years of demonstrated success in Stars and HEDIS. We offer an end-to-end integrated and tailored solution that delivers improved Star Ratings and HEDIS scores through proven strategic initiatives. We leverage our unique health plan knowledge and clinical expertise to create an innovative offering that delivers 4-Star program performance.

The purpose behind our passion.

Helping people live longer, healthier lives.

Contact Tessellate