ASSURE IQ

Turn payer intelligence into confident action.

A clinician explaining a scan to a colleague

What is ASSURE IQ

ASSURE IQ brings intelligence to payer risk adjustment, quality, and compliance—helping health plans identify where risk exists, where opportunity is emerging, and where action can create the greatest impact. By combining AI, advanced analytics, intelligent workflows, and deep payer expertise, ASSURE IQ helps health plans modernize retrospective operations, improve coding accuracy and audit defensibility, identify risk and quality opportunities earlier, and direct resources toward the work that matters most.

Value

Clinicians reviewing information on a screen

Modernize retrospective operations

Make foundational payer operations more intelligent and efficient.

Focus resources where they matter most

Direct teams toward higher-value work and opportunities.

Improve coding accuracy & audit defensibility

Strengthen confidence in coding decisions and supporting evidence.

Identify opportunities earlier

Surface risk and quality opportunities while there is still time to act.

We don’t just process payer data. We activate intelligence.

ASSURE IQ combines technology with the operational expertise required to put intelligence to work.

AI & analytics

Identify patterns, risk, and opportunity.

Intelligent workflows

Prioritize and route work to the right team.

Payer operations experts

Omega’s coding, audit, quality, and payer operations experts provide the judgment required for complex exceptions and higher-risk decisions.

Performance analytics

Create greater visibility into what is happening across the operation.

Technology-led. Human-guided. Outcome-accountable.

ASSURE IQ helps health plans modernize the work they perform today while creating the intelligence foundation for a more proactive payer operating model.

One Portfolio. Two ways to transform payer performance.

Make retrospective operations more intelligent, efficient, and defensible.

ASSURE IQ modernizes foundational risk-adjustment operations by combining automation, intelligent workflow, analytics, and expert oversight—greater efficiency without sacrificing accuracy, transparency, and defensibility.

Autonomous Coding Intelligence
Multi-Model Risk Adjustment
Coding Audit & Defensibility Intelligence
Risk Analytics Intelligence
Chart & MRN Workflow Intelligence

Modernize the Core

Make retrospective operations more intelligent, efficient, and defensible. The result is greater efficiency without sacrificing the accuracy, transparency, and defensibility health plans require.

01 / 05

Autonomous Coding Intelligence

Automate the routine. Focus expertise where it matters.

ASSURE IQ uses AI-enabled coding and confidence-based routing to identify charts eligible for autonomous processing while directing complex cases and exceptions to expert review.

Outcome

Lower cost per chart. Greater coding capacity. Faster throughput. Consistent quality.

What ASSURE IQ helps you do:

Automate eligible coding workflows
Identify charts requiring human intervention
Route complex cases for targeted over-read
Support HCC identification and validation
Apply QA and coding controls
Monitor coding accuracy and performance
Improve throughput without proportional labor growth

02 / 05

Multi-Model Risk Adjustment

Manage risk across more of your covered population.

ASSURE IQ extends risk-adjustment workflows beyond traditional Medicare Advantage and ACA models to support Medicaid populations and additional risk methodologies. Configurable workflows, coding logic, QA, and analytics help health plans manage increasingly diverse risk populations through a more consistent operating model.

Outcome

Broader risk-model coverage. Greater coding consistency. More scalable risk-adjustment operations.

What ASSURE IQ helps you do:

Support Medicare Advantage risk adjustment
Support ACA risk-adjustment workflows
Extend workflows into Medicaid populations
Support CDPS, ACG, and Milliman-related risk models
Configure coding and QA workflows by population
Apply consistent coding governance
Analyze performance across risk models

03 / 05

Coding Audit & Defensibility Intelligence

Build confidence into every coded chart.

ASSURE IQ integrates coding QA, audit workflows, transparency, and issue resolution directly into the operating model. Health plans gain greater visibility into coding quality while reducing reliance on disconnected third-party audit processes.

Outcome

Greater audit readiness. Faster QA resolution. Improved coding consistency. Stronger defensibility.

What ASSURE IQ helps you do:

Perform client-facing coding audits
Configure audit sampling
Score coding quality
Compare coding and audit findings
Manage dispositions and disagreements
Identify recurring coding issues
Track resolution
Maintain an auditable record of decisions

04 / 05

Risk Analytics Intelligence

Know where risk and opportunity exist before deciding where to work.

ASSURE IQ combines risk-score visibility, chart identification, audit exposure, documentation-defensibility indicators, and opportunity scoring to help health plans move from volume-based processing toward intelligence-led prioritization. Instead of treating every chart or opportunity equally, teams gain greater visibility into where attention can create the most value.

Outcome

Better prioritization. Earlier identification of risk and value. Greater visibility into payer performance.

What ASSURE IQ helps you do:

View risk-score performance
Identify high-value charts
Surface potential audit exposure
Assess documentation-defensibility indicators
Score opportunities based on potential value
Prioritize work based on risk and opportunity
Create actionable intelligence for payer teams

05 / 05

Chart & MRN Workflow Intelligence

See the complete record. Act with encounter-level precision.

ASSURE IQ supports both longitudinal member records and encounter-level coding and correction—giving health plans greater flexibility in how retrospective and concurrent work is managed.

Outcome

Less avoidable rework. Faster resolution. Greater encounter accuracy. Improved submission readiness.

What ASSURE IQ helps you do:

Aggregate longitudinal member records
Manage up to 2.5 years of chart history
Work at the individual encounter level
Reconcile partial encounters
Avoid unnecessary recoding
Track workflow and coding status
Improve submission readiness
Maintain workflow and audit history

Move Intelligence Upstream

Find the opportunity while there is still time to act.

Modernizing retrospective operations creates the foundation. ASSURE IQ builds on it by helping health plans identify risk, quality, compliance, and documentation opportunities earlier—and convert those insights into prioritized work.

The operating question changes“How efficiently can we process the chart?”“Where is our greatest risk or opportunity—and what should happen next?”

01 / 05

Prospective & Concurrent Risk Adjustment Intelligence

Find risk opportunity before it becomes retrospective work.

ASSURE IQ helps health plans identify potential risk-adjustment opportunities earlier through prospective detection, concurrent review, HCC recapture, missed-diagnosis likelihood, and documentation-confidence scoring. Opportunities can then be prioritized across members and providers based on potential risk and value.

Outcome

Earlier risk closure. More complete risk representation. Reduced retrospective burden. Stronger RAF integrity.

What ASSURE IQ helps you do:

Detect prospective risk opportunities
Support concurrent chart review
Identify HCC recapture opportunities
Surface potential missed diagnoses
Assess documentation confidence
Prioritize members and providers
Support provider documentation workflows
Analyze RAF opportunity

02 / 05

RADV & Audit Readiness Intelligence

Find defensibility risk before the auditor does.

ASSURE IQ helps health plans identify diagnoses that may lack adequate supporting evidence and prioritize potential audit exposure before external review. Evidence validation, defensibility scoring, audit sampling, and chart-level lineage help create a more proactive model for RADV readiness.

Outcome

Greater defensibility. Reduced unsupported-HCC exposure. Faster audit response. Lower manual audit burden.

What ASSURE IQ helps you do:

Identify potentially unsupported diagnoses
Assess documentation defensibility
Score potential audit exposure
Validate supporting evidence
Prioritize higher-risk diagnoses
Prepare audit samples
Build audit-ready packages
Maintain chart-level lineage

03 / 05

HEDIS & Stars Intelligence

Finding the gap isn’t the outcome. Closing it is.

ASSURE IQ helps health plans identify and prioritize quality gaps while improving the workflows required to review evidence and move opportunities toward resolution. By connecting measure logic, evidence extraction, abstraction workflows, supplemental data, and intelligent work queues, ASSURE IQ helps quality teams focus on the opportunities that matter most.

Outcome

Greater quality-gap closure. Improved abstraction productivity. Stronger measure performance.

What ASSURE IQ helps you do:

Detect HEDIS and quality gaps
Extract supporting clinical evidence
Support abstraction workflows
Review supplemental data
Prioritize quality opportunities
Support provider follow-up
Support member follow-up workflows
Monitor gaps throughout the year

04 / 05

Policy & Compliance Intelligence

Turn regulatory change into operational action faster.

Payer requirements do not stand still. ASSURE IQ helps monitor changes across CMS policy, HCC models, HEDIS requirements, RADV guidance, and payer-specific rules—then helps translate those changes into operational workflows.

Outcome

Faster policy response. More consistent rule adoption. Reduced compliance exposure.

What ASSURE IQ helps you do:

Monitor regulatory changes
Track HCC-model updates
Monitor HEDIS changes
Identify RADV policy changes
Track payer-specific requirements
Assess potential operational impact
Update workflow rules
Create visibility into policy adoption

05 / 05

Intelligent Work Queues

Another dashboard isn’t the answer.

Health plans already have enormous amounts of data. The challenge is deciding what deserves attention. ASSURE IQ converts analytics into prioritized work by scoring charts, members, providers, audit findings, exceptions, and quality opportunities based on risk, value, urgency, and confidence. Work can then be assigned and routed to the appropriate team while progress and outcomes are tracked.

ASSURE IQ helps answer four questions:

01 What matters?
02 What should happen next?
03 Who should act?
04 What happened after the action?

Outcome

Faster action. Less manual triage. Greater opportunity yield. Improved operational throughput.

What ASSURE IQ helps you do:

Prioritize charts, members, and providers
Score risk and quality opportunities
Create RADV and audit queues
Manage coding over-read
Route exceptions
Prioritize work based on value
Assign work to appropriate resources
Monitor SLA performance
Track workflow outcomes

Outcomes by Design

Intelligence is only valuable when it improves performance. ASSURE IQ is designed to help health plans improve measurable performance across risk adjustment, quality, compliance, and payer operations.

01Reduce Cost to ServeAutomate eligible work and direct human expertise toward higher-value exceptions.
02Improve Risk AccuracyIdentify coding, documentation, and risk opportunities with greater precision.
03Strengthen DefensibilitySurface potential exposure earlier and improve evidence, audit, and QA transparency.
04Increase ProductivityReduce manual review, rework, audit burden, and workflow triage.
05Improve Quality PerformanceIdentify and prioritize quality gaps and improve abstraction and gap-management workflows.
06Accelerate ActionConvert analytics into prioritized work instead of another report or dashboard.
07Strengthen ComplianceIdentify regulatory change earlier and translate changing requirements into operational workflows.

Turn payer intelligence into confident action.

See where ASSURE IQ can help modernize payer operations, identify risk and opportunity earlier, and focus resources on the actions that matter most.

Explore your Payer Performance opportunity

From charts to opportunities

ASSURE IQ changes the unit of value.

Traditional payer operations have largely measured work at the chart level: How many charts did we retrieve? How many did we code? How quickly did we process them? Those measures still matter. But ASSURE IQ creates a path toward a more valuable question:

“Where is the payer’s greatest opportunity—and how can we turn intelligence into action?”

Volume
Intelligence
Processing
Prioritization
Retrospective
Proactive
Insight
Action

Action Through Intelligence. Proven Through Outcomes.

Contact Us

A clinician reviewing results on a tablet with a colleague

ASSURE IQ

What is ASSURE IQ

AI

Advanced analytics

Intelligent workflows

Deep payer expertise

Value

Modernize retrospective operations

Focus resources where they matter most

Improve coding accuracy & audit defensibility

Identify opportunities earlier

We don’t just process payer data. We activate intelligence.

AI & analytics

Intelligent workflows

Payer operations experts

Performance analytics

One Portfolio. Two ways to transform payer performance.

Make retrospective operations more intelligent, efficient, and defensible.

Modernize the Core

Autonomous Coding Intelligence

Multi-Model Risk Adjustment

Coding Audit & Defensibility Intelligence

Risk Analytics Intelligence

Chart & MRN Workflow Intelligence

Move Intelligence Upstream

Prospective & Concurrent Risk Adjustment Intelligence

RADV & Audit Readiness Intelligence

HEDIS & Stars Intelligence

Policy & Compliance Intelligence

Intelligent Work Queues

Outcomes by Design

Turn payer intelligence into confident action.

ASSURE IQ changes the unit of value.

Action Through Intelligence. Proven Through Outcomes.

Contact Us