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.
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.
Our Tech
Our technology enables seamless operations and improves procedural efficiency reducing processing time by up to 50% and resulting in higher satisfaction.
A robust system to collect, track and maintain data through the latest technology and infrastructure.
All verification and legitimization processes comply with NCQA, URAC, and JCAHO standards.
Highest productivity and quality standards with competitive pricing.
Secure storage of all documents on the client’s server, less chance of a breach.
More acquainted with payor requirements for the credentialing.
Our Edge
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 (RAF) / Medicare Risk Adjustment (MRA)
