Monthly Analytics Sample Clauses

Monthly Analytics. Inovalon shall, on a monthly basis, apply its algorithms to Health Plan Data Sets to perform analysis of member historical clinical patterns, disease, and co-morbidity states (including for both the previous and current calendar years) to identify members with Prospective Advantage Gaps and therefore without any, or without adequate, claims and risk adjustment impact coding, during the then current calendar year (the “Current DOS Period”). For each monthly process, Inovalon shall undertake the following: i. Identification of Prospective Advantage Gaps: 1. Identify Documentation Gaps per the application of Inovalon’s Predictive PCIS designed to determine the identification of members possessing clinical indications of disease and co-morbidity states not otherwise present within Client administrative claims data systems, otherwise known as Clinical Encounter Data Incongruences (each a “CEDI”), the probability and factor score thresholds of which shall be determined and set upon review of Member Population data by Inovalon. A. Provided that Client is concurrently engaged with Inovalon’s CARA™ solution, all CEDI Documentation Gaps shall be integrated from the respective CARA processes and no duplication of such processes or associated CEDI identification fees shall be applied. 2. Identify Assessment Gaps per the application of Inovalon’s PCIS designed to determine the identification of members possessing historical indications of chronic disease (or such medical conditions which may be expected to be persistent in nature) and for which a valid clinical encounter and associated valid claim is not able to be identified within the current date of service period per the CMS (or State Department of Health, as the case may be) technical specifications of risk adjustment, otherwise known as Un-Coded Chronic Conditions (each a “UCCC”), the probability and factor score thresholds of which shall be determined and set upon review of Member Population data by Inovalon. 3. Identify Care Consideration Gaps per the application of PCIS designed to determine the identification of members with data suggesting potential medication, laboratory, procedure, outcome, resource utilization, or other patient care issue that is identified as potentially having occurred or not occurred such that best practice, utilization improvement, quality measure, or safety standards may have been jeopardized.