Redetermination Ready. Data Reconciled. Risk Captured.
Smarter Medicaid risk analytics
To power care, compliance, and financial integrity.
Managed Medicaid
Overview
Medicaid managed care organizations (MCOs) are under growing pressure. Eligibility redetermination, chronic under-documentation, and fragmented encounter data make accurate risk adjustment and care coordination especially difficult.
Add to that line-of-business silos and variable vendor performance, and health plans risk losing not just revenue—but members and compliance standing.
Invent Health helps Medicaid and Medi-Cal plans optimize risk capture, improve encounter integrity, and power meaningful member outreach—especially for high-need and vulnerable populations. Our Modular Analytics Platform (MAP) integrates structured and unstructured data to deliver actionable insights across redetermination, quality, coding, and financial performance.
Highlights
Key Capabilities
AWV/IHA Optimization for Medicaid
NLP-Driven Encounter Validation & Audit Readiness
Invent Health Medicaid
Use Case Snapshot
Medi-Cal/Medicaid
Plan Profile
- Lives Covered: 600,000+ across Medi-Cal and Medicaid plans
- Regions Served: California + multi-state Medicaid MCOs
- Chart Reviews/Yr: 85,000
- Duals Population: 120,000
Results
- Redetermination Retention Rate: ↑ from 62% to 81%
- AWV/IHA Participation: ↑ from 25% to 51%
- Coding Accuracy: ↑ from 70% to 92% with NLP + coder QA
- Encounter Acceptance Rate (Medi-Cal): ↑ from 78% to 96%
- RAF Lift: ↑ 7–9% score improvement with gap closure + suspecting
Contact us
Purpose-Built for Public Programs
Schedule a demo and see how Invent Health strengthens Medicaid performance.
Our Blog
Healthcare Insights,
Made Simple
Explore expert perspectives on risk adjustment, AI-powered analytics, and healthcare innovation. Stay informed with actionable insights designed for health plans, providers, and managed care organizations.
Modular Analytics Platform (MAP)
Discover how Invent Health’s Modular Analytics Platform (MAP) improves risk adjustment, care coordination, and financial performance for health plans.
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