Skip to main content

RAF Score Capture for Payers & Health Plans

Your Members Have Chronic Conditions.
Your RAF Scores Don’t Reflect It.

Every uncaptured HCC code is lost revenue for the full plan year. We activate members to complete the visits where RAF capture happens — on time, every year.
Schedule a Consultation
Back to Payers

The Challenge

The RAF Capture Problem

RAF scores drive your revenue. But the members whose conditions need to be captured are the hardest to engage — and automated reminders aren’t moving them.

Inaccurate RAF scores cost you revenue on every attributed member

When HCC codes aren’t captured during annual wellness visits or chronic care encounters, your risk adjustment revenue drops. Every uncaptured condition is money you’ve earned but never collected.

Members skip the visits where RAF capture happens

Annual wellness visits, chronic care management appointments, and comprehensive assessments are the encounters where HCC codes get captured. When members don’t show up, the codes don’t get documented.

Automated reminders about ‘annual check-ups’ don’t create urgency. Members see them as optional. The visits that matter most for RAF capture are the ones members are most likely to skip.

Without clear, immediate guidance and friction-free next steps, anxious patients default to the emergency department.
Root Cause

As Healthcare Experts, We See the Deeper Problem

RAF capture isn’t a coding problem. It’s a visit completion problem. And visit completion for complex chronic members requires barrier resolution and activation, not reminders.
REVENUE AT RISK

Every uncaptured HCC code is lost revenue for the full plan year

RAF scores determine capitation rates. When chronic conditions go undocumented because the member didn’t complete the encounter, your revenue for that member is lower than it should be — for the entire year.
VISIT COMPLETION

The visits that drive RAF capture have the highest no-show rates

Members with the most chronic conditions — and therefore the most HCC codes to capture — are often the hardest to engage. They face the highest barrier burden and need the most activation to complete visits.
PROVIDER ALIGNMENT

Network providers aren’t always capturing codes at the encounter

Even when members complete visits, providers may not document all relevant HCC codes. The capture problem has two stages: getting the member to the visit, and ensuring the visit captures everything.
TIMING

RAF capture is a calendar-year game — and the window closes fast

HCC codes must be captured within the measurement year. Members who haven’t completed their annual visit by Q3 represent rapidly diminishing time to capture. Activation urgency increases every month.
Our Approach

Activation-Driven RAF Capture

We activate members to complete the visits that capture HCC codes — prioritizing by risk, resolving barriers, and confirming visit completion through closed-loop follow-up.

  • Activation-driven outreach for RAF-critical visits

    Our agents don’t just remind members about annual visits. They use behavioral science to create urgency, resolve barriers, and schedule the appointment during the call.

  • Risk-stratified prioritization

    Members with the highest suspected HCC burden are prioritized first. Our platform identifies which members represent the largest RAF capture opportunity.

  • Barrier resolution for high-complexity members

    Members with multiple chronic conditions face more barriers. Transportation, specialist coordination, medication concerns — we resolve them before they become no-shows.

  • Closed-loop visit confirmation

    We don’t just schedule the visit. We follow up to confirm the member attended, the encounter was documented, and the relevant codes were captured.

  • Integration with your population health data

    We work from your member data to identify gaps, track completions, and report on RAF capture progress in real time.

PROVEN AT SCALE

Maximizing RAF Revenue Through Member Activation

When members complete RAF-critical visits, your risk adjustment revenue reflects the true acuity of your population.
5×
Activation rate increase
40%
Visit activation rate
99.4%
QA pass rate
24/7
Coverage available

Ready to capture the RAF revenue you’re leaving on the table?

Schedule a consultation and see how activation-driven outreach can improve your RAF accuracy and risk adjustment revenue.

Schedule a Consultation