ACA risk adjustment

The Affordable Care Act (ACA) presents health plans with a uniquely challenging environment: high member churn, limited retrospective visibility, and tight margins in a zero-sum risk adjustment program. Most plans struggle to track risk accurately across years and lines of business—especially when prior data comes from Medicaid or Commercial sources. 

Invent Health’s ACA solution delivers end-to-end visibility, actuarial-grade accuracy, and seamless EDGE submission alignment, helping health plans maximize their net transfer payments while improving preventive care engagement. 

Whether you’re dealing with fragmented claims, bundled encounters, or limited suspecting capabilities, our platform brings order, automation, and intelligence to the ACA risk adjustment process.