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Encounter Data Processing System
Encounter Data Processing System
Our EDPS/RAPS solution receives, processes, transmits complete and compliant 837 data to CMS and applies responses automatically. This ensures compliance for Health Plans and strengthens their financial performance with improved insight and decision making.
Why our EDPS is preferred by Health Plans
Error Correction
Rank and prioritize error correction activities by HCC
De-dup of RAPS clusters
De-dup of RAPS clusters to meet CMS compliance
Manage and interpret CMS
Quickly manage and interpret CMS error reports
Define and reconcile discrepancy
Reconcile discrepancy gaps between Claims, EDPS, RAPS, MAO-002 and MAO-004
HIPAA and CMS specific edits
Perform HIPAA and CMS specific edits on encounter data before submission to CMS
Track diagnosis
Track diagnosis back to the source files and reconcile with CMS responses and reports
Why our EDPS is preferred by Health Plans
Error Correction
Rank and prioritize error correction activities by HCC
De-dup of RAPS clusters
De-dup of RAPS clusters to meet CMS compliance
Manage and interpret CMS
Quickly manage and interpret CMS error reports
Define and reconcile discrepancy
Define and reconcile discrepancy gaps between EDPS-RAPS and MAO-002-MAO-004
HIPAA and CMS specific edits
Perform HIPAA and CMS specific edits on encounter data before submission to CMS
Track diagnosis
Track diagnosis back to the source files and reconcile with CMS responses and reports
Features at a glance
Ability to generate CMS compliant 837 (v5010) format files
Ability to convert customer files to internal formats
Ensure accurate, complete and compliant encounter submissions (Rule Engine)
Ability to split customer input file in to multiple 837 files, based on CMS regulations
Real-time file status tracking system with batch schedule
Reconcile the source and corresponding response files
Generate unique submission file Ids
Generate unique encounter ids for each encounter submitted
Generate unique file ids for each file received
Automate the receiving and processing of CMS responses to encounter transactions – TA1, 999, and 277CA, MAO002
Apply MAO004
Apply invalid RSP and MAO001 responses
Manage and quickly interpret CMS errors
Automatically classify encounter rejections by type (Provider, Diagnosis, Procedure etc...)
Rank and prioritize error correction activities by risk score
Ability to assign the rejected encounters to respective group and person at customer
Ability to track diagnosis back to the source files and reconcile with CMS responses and reports
File received dashboard based on submission year
File Status dashboard based on submission year
Encounter error distribution dashboard based on service year
Encounter distribution dashboard by frequency code based on service year
Reconcile number of encounters and chart reviews received for each LOB, based on service year
Ability to link the duplicate encounter to its original encounter
Ability to show CMS MAO002 Acceptance Rate per service year
Ability to show Total Rejection Rate per service year
Provision to do search on Service year, Submitter ID, HPlan ID & Submission Year in dashboard screen
Screens to show accepted/pending encounter and chart review list
Screens to show rejected encounter and chart review list
Provision to do search by Hplan ID, Provider NPI, Member ID, Encounter ID, Type, File Name in cluster screen
Detail Screen to show encounter and chart reviews based on plan claim number
Ability to show all the submissions made irrespective of accepted/rejected or newest/oldest
Display source file name against every encounter in detail screen
Display error details for rejected encounters
Ability to do individual corrections through web portal
Reconcile discrepancy gaps between MAO-002 and MAO-004
GUI to create Linked chart review
Allow user to search using plan id, member id, encounter ID, service date, NPI to identify the encounter to create linked chart review
GUI to create Unlinked chart review
Option to view the create Linked and unlinked chart review in UI
Ability to delete or hold the chart review created before it is processed through webportal
Process to create chart review 837 created via GUI
Process to create 837 for corrected/resubmission encounters
Automatically process the resubmission from CMS
Provision to upload files using web portal for processing
Admin portal to allow user to add/delete users, plan ids, submitter ids
Provision to SFTP the files for processing
Ad hoc reports
Extract and download Process
Data Masking logic
Duplicate encounter validation
Provider NPI validation
Allow HICN and MBI search and validation
Ability to load historical data
Ability to avoid duplicate file submissions
Ability to avoid duplicate transaction set submissions
Store historical data (Archival process)
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EDPS is a CMS and HIPPA* compliant processing solution that manages front-end testing, end-to-end testing, and certification logistics.
Why choose MIRRA’s® EDPS and RAPS?
Every health plan faces a challenge reconciling EDPS to RAPS or prioritizing encounter correction efforts using risk scores. Our experience dealing with the complexities of this process drove us to create a highly simplified and optimized product suite to cater these needs.
Medicare Advantage health plans can now drill down to the details, forecast results, re-allocate resources and do much more at the click of a button. Our solution will aid risk managers in identifying and prioritizing encounters by risk, reconciling discrepancies and positively impact revenue.
Reviews & Testimonials
NANCY GAREAUCEO of Ultimate Health Plans
Recover Revenues with Our CMS Reject Analysis!
Reach out for a no-obligation consult today.