EDPS/RAPS

Increased data accuracy.
Reduced denials.

Our EDPS/RAPS solution for health plans ensures compliance with CMS and improves insight and decision making, strengthening their financial performance.

Glossary

EDPS and RAPS

Encounter Data Processing System (EDPS)

Encounter Data Processing System (EDPS) assists plans in submitting accurate encounter data to the Centers for Medicare and Medicaid (CMS). EDPS is a CMS and HIPAA-compliant processing solution that manages front-end testing, end-to-end testing, and certification logistics. EDPS data is edited for enrollment, duplicates, diagnosis codes, CPT codes as well as coverage and clinical consistencies. EDPS data must also pass CCI edits like those used with FFS claims.

RAPS

RAPS: Risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll. By risk adjusting plan payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Increased accuracy benefits patients, providers, health plans, and the nation as a whole. RAPS data is edited for: enrollment, duplicates, and validity of diagnosis codes.

Encounter Data Processing System (EDPS) assists plans in submitting accurate encounter data to the Centers for Medicare and Medicaid (CMS). EDPS is a CMS and HIPAA-compliant processing solution that manages front-end testing, end-to-end testing, and certification logistics. EDPS data is edited for enrollment, duplicates, diagnosis codes, CPT codes as well as coverage and clinical consistencies. EDPS data must also pass CCI edits like those used with FFS claims.

RAPS: Risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll. By risk adjusting plan payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Increased accuracy benefits patients, providers, health plans, and the nation as a whole. RAPS data is edited for: enrollment, duplicates, and validity of diagnosis codes.

Our EDGE

Experience. Expertise. Execution.

Real-time dashboards and admin portal.

Submission and coding gap analysis.

Import any file format; map and transform data into 5010 X12 837.

Projection of Risk Adjustment Factor / Medicare Risk Adjustment.

Why HOM

Improve procedural efficiency.

Prevent revenue leakage

We provide Medicare advantage health plans with solutions for submitting accurate encounter/RAPS data to CMS.

Multi Platform Support

EDPS/RAPS receives encounters/RAPS data, validates as per CMS and HIPAA guidelines (encounter), de-duplicates the cluster (RAPS), and transmits complete and compliant 837 encounters/RAPS data to CMS.

Steady revenue generation

HOM’s solution will help the risk manager to identify and prioritize encounters by risk, reconcile discrepancies, and positively impact revenue.

We provide Medicare advantage health plans with solutions for submitting accurate encounter/RAPS data to CMS.

EDPS/RAPS receives encounters/RAPS data, validates as per CMS and HIPAA guidelines (encounter), de-duplicates the cluster (RAPS), and transmits complete and compliant 837 encounters/RAPS data to CMS.

HOM’s solution will help the risk manager to identify and prioritize encounters by risk, reconcile discrepancies, and positively impact revenue.

Know more about our capabilities in
EDPS and RAPS

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