Identify errors, and prioritize rejections by HCC and financial impact.
Submit encounter data and handle CMS processing, transformation, and edits, including submission, matching, and processing of supplemental data. By automating the receiving and processing of CMS responses to claim transactions, users can manage and resolve errors by category and type.
Benefit from filtering encounter errors at the HCC level to be worked first. Access a robust reporting engine that provides analysis and reporting of EDPS and RAPS comparable outcomes to enable HCC reconciliation between both submissions.
Ensure accurate, complete and compliant encounter submissions with a one-stop tool for error management, reconciliation, and financial analytics
Streamline reconciliation of RAPS with Encounter Data, identifying missing HCCs, and inaccuracies in either format
Robust segmentation capacities allow you to identify and prioritize errors with the highest HCC impact
Obtain visibility into summary level dashboards showing total financial impact at the plan level
EDPS and RAPS filtering of CMS EDS results with filter criteria edits easily configured by payer
Analysis and reporting of EDPS and RAPS comparable outcomes to enable HCC reconciliation between both submissions
In-app guides for quick error queue correction
ROBUST DATA MANAGEMENT
Extract, transform, and consolidate encounter data for submission to CMS paired with operational reporting
STREAMLINED CLAIM TRANSACTIONS
Generate and submit clean claims transactions required for all encounter types (X12 5010 837 I, P and DME)
FULL-RANGE OF SUPPORT TOOLS
Support all variations of encounters including: standard, capitated, void and adjusted, chart linked and unlinked, and deleted, as well as encounters from atypical providers
DETAILED AND ACTIONABLE
Load and process CMS responses to claims transactions (TA1, 999, 277CA, MA-002, & MA-004)
RESOLUTION & CORRECTION
Get access to highly configurable and robust error queue management
TOTAL FINANCIAL IMPACT
View accurate financial impact at the plan level