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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 to meet CMS compliance

Quickly manage and interpret CMS error reports

Reconcile discrepancy gaps between Claims, EDPS, RAPS, MAO-002 and MAO-004

Perform HIPAA and CMS specific edits on encounter data before submission to CMS

Track diagnosis back to the source files and reconcile with CMS responses and reports

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Why our EDPS is preferred by Health Plans

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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

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Features at a glance

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Ability to generate CMS compliant 837 (v5010) format files

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Ability to convert customer files to internal formats

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Ensure accurate, complete and compliant encounter submissions (Rule Engine)

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Ability to split customer input file in to multiple 837 files, based on CMS regulations

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Real-time file status tracking system with batch schedule

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Reconcile the source and corresponding response files

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Generate unique submission file Ids

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Generate unique encounter ids for each encounter submitted

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Generate unique file ids for each file received

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Automate the receiving and processing of CMS responses to encounter transactions – TA1, 999, and 277CA, MAO002

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Apply MAO004

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Apply invalid RSP and MAO001 responses

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Manage and quickly interpret CMS errors

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Automatically classify encounter rejections by type (Provider, Diagnosis, Procedure etc...)

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Rank and prioritize error correction activities by risk score

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Ability to assign the rejected encounters to respective group and person at customer

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Ability to track diagnosis back to the source files and reconcile with CMS responses and reports

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File received dashboard based on submission year

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File Status dashboard based on submission year

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Encounter error distribution dashboard based on service year

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Encounter distribution dashboard by frequency code based on service year

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Reconcile number of encounters and chart reviews received for each LOB, based on service year

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Ability to link the duplicate encounter to its original encounter

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Ability to show CMS MAO002 Acceptance Rate per service year

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Ability to show Total Rejection Rate per service year

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Provision to do search on Service year, Submitter ID, HPlan ID & Submission Year in dashboard screen

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Screens to show accepted/pending encounter and chart review list

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Screens to show rejected encounter and chart review list

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Provision to do search by Hplan ID, Provider NPI, Member ID, Encounter ID, Type, File Name in cluster screen

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Detail Screen to show encounter and chart reviews based on plan claim number

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Ability to show all the submissions made irrespective of accepted/rejected or newest/oldest

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Display source file name against every encounter in detail screen

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Display error details for rejected encounters

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Ability to do individual corrections through web portal

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Reconcile discrepancy gaps between MAO-002 and MAO-004

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GUI to create Linked chart review

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Allow user to search using plan id, member id, encounter ID, service date, NPI to identify the encounter to create linked chart review

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GUI to create Unlinked chart review

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Option to view the create Linked and unlinked chart review in UI

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Ability to delete or hold the chart review created before it is processed through webportal

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Process to create chart review 837 created via GUI

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Process to create 837 for corrected/resubmission encounters

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Automatically process the resubmission from CMS

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Provision to upload files using web portal for processing

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Admin portal to allow user to add/delete users, plan ids, submitter ids

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Provision to SFTP the files for processing

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Ad hoc reports

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Extract and download Process

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Data Masking logic

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Duplicate encounter validation

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Provider NPI validation

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Allow HICN and MBI search and validation

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Ability to load historical data

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Ability to avoid duplicate file submissions

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Ability to avoid duplicate transaction set submissions

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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.

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Reviews & Testimonials

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NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

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