With providers submitting encounters and claims every month, it is not enough to process the diagnosis codes to the health plan and to CMS. The cost of not caring each year for a member's chronic disease burden grows when it has not been reported each year. HCC Manager is designed to help physician organizations and health plans account for the risk associated with the ICD-9 codes submitted and manage the completion of the annual service delivery for chronic disease.

HCC Manager maps the encounter submission to the individual member's account, internally calculates the annual HCC factor total, and compares the result to the capitation payment by CMS or the health plan. Where there are discrepancies, encounters can be resubmitted to the plan before the final cutoff for payment. Reports are generated by provider to remind them which patients have not yet been seen before the end of the treatment year.

HCC Manager is at the heart of a Risk Adjustment Management Program. MDX can assist its clients with coding expertise, physician coding training, and chart review. In addition to development of an audit and compliance program, MDX can assist with the establishment of risk adjustment capitation for provider, the development of fee for service payments for annual documentation of chronic care, and the deployment of outreach programs for the home bound and members in skilled nursing facilities.