Daylight
One platform for ACA risk adjustment and member economics
Daylight connects your enrollment, claims, and EDGE server data, then answers the questions ACA plans ask every year: which members make money, which conditions go uncoded, which claims EDGE isn't counting, and what each gap is worth in dollars.
Modules and Features
Member Profitability
See profit and loss for every member, and aggregate it by plan, metal level, rating area, PCP, HCC, clinical category, broker, or anything else in your data. At the member level, we calculate premium, claims, risk adjustment transfer, IBNR, reinsurance/HCRP, commissions, and administrative costs. Test pricing and scenario assumptions before you file, not after, and find what conditions and attributes drive margin and which ones drive losses.
Leading EDGE®
Find out which claims the EDGE server isn't counting, and what each one would be worth if it were accepted, including both risk score value and High Cost Risk Pool / state reinsurance recovery (where applicable). Claims EDGE rejected, claims you never submitted, and claims EDGE never received each get their own category, ranked by dollar value, so your team works the most valuable ones first.
HCC Suspecting
Find conditions your members probably have that aren't coded on any claim, using models trained on millions of ACA members. This isn’t a black box: every suspect shows the evidence behind it and the level of confidence in the suspect. HCC suspecting uses a combination of machine learning modules, prior year coding data, and deterministic rules to provide a comprehensive suspecting list
PCP Attribution
Flexible PCP attribution module that assigns PCPs using medical and pharmacy claims, at the group or provider level. Use default specialty model, or configure your own approach. Manual assignments also accepted through a simple import function or directly in the intuitive user interface.
HCC Coding Workflows
Manage your team of coders, analysts, and outreach specialists to chase charts, schedule visits, and create supplemental records to ensure your ACA data is accurate, driven by our HCC suspecting module. Prioritize by dollar value, RADV risk, confidence level, or PCP. Set quality control: random sample review or 100% over-read.
RADV Risk Management
Understand your RADV risk: find the codes and members most likely to be selected for RADV. Validate members with conditions that may be inaccurate such as acute HCCs from prior years that may not hold up this year. See the financial impact of deletes. Benchmark your RADV performance and understand how ACA RADV actually works in your population.
Built by ACA Experts
Evensun's founders were CFOs at ACA, Medicare, and Medicaid health plans. We built Daylight because we needed these answers and couldn't get them. Our clients are mostly provider-sponsored, regional, and blues plans, and we built this product to help us answer the questions and solve the challenges faced by health plans of all sizes.
Daylight has no black boxes: everything is exportable, and all assumptions used in developing models are clear and editable. Pricing starts at $100,000 per year, with bundled discounts for customers of our EDGE submissions product. Reach out to us at joe@evensun.com for more information and for a demo. A demo account with test data can also be provided.
Flexible Importing
Your file doesn’t need to be exactly right. We provide a standard spec, but we know everyone interprets fields differently, so our flexible import user interface can apply transformations, adjustments, and conditionals to import your data without substantial rework; use your standard export and let our system interpret it.
Secure and Compliant
Your data sits in its own dedicated, encrypted database, on our premises, and access is IP-restricted. Authentication leverages Microsoft Entra ID, or we can integrate with your identity provider of choice so you control who has access. Granular permission settings for your users ensure only the minimum necessary access is granted. Evensun is HIPAA compliant and maintains a SOC 2 Type 2 audit available in our trust center.