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Risk Adjustment Overview

Risk adjustment helps align payments to health plans based on the demographics (e.g., age and gender) and health status of members.

Accurate risk adjustment relies on comprehensive, face-to-face health assessments of patients that allow for appropriate medical record documentation and diagnosis coding. The diagnosis codes are then submitted to Horizon and used to determine the level of risk associated with the patient.

Horizon participates in Commercial (Individual and Small Group and supports Medicaid and Medicare Advantage risk adjustment programs.

Visit Risk Adjustment In Depth.


Risk Adjustment Overview

Risk Adjustment Coding Checklist

Complex Case Management Trigger Events

ICD-10-CM Clinical Documentation Improvement for Chronic Conditions

Care Management Programs

Horizon NJ Health Medicaid Risk Adjustment