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.
