MANAGED MEDICAID

The rules for encounter data submissions vary according to each state. Our associates have in-depth experience interacting with all of the major financial intermediaries in the market today.

EDRS can help you build the same reconciliations that the states or their auditors are performing against your data so that you always know where you stand and can remediate problems before it is too late. We may also uncover issues with the financial reporting that could be incorrectly making your encounter data appear to be deficient. Or, as we have observed in some cases, the states or their auditors may have methodology issues with the reconciliation that need to be addressed.

ENCOUNTER RECONCILIATIONS

More and more states are moving to reconciling encounter data to other financial reporting. And they allow very little variance. Learn how we can help.


(Hover over image for more info)

RISK ADJUSTMENT

After investing money and time ensuring that your member’s diagnoses are complete, are you sure that you are getting everything you can out of those efforts? Learn how we can help.


(Hover over image for more info)

When pursuing retroactive risk adjustment opportunities, it is critical that these data be sent and accepted by the state agency. Every diagnosis code tracked down, but not sent and accepted, is a waste of time and money. We can help you build robust tracking that ensures that you get the most out of your risk adjustment efforts. Beyond that, we can also help you optimize how diagnostic information is submitted on your encounters. In several states, only the first few diagnosis codes on encounters submitted are captured within the state MMIS. Where allowable, we can help you build processes that look at a member’s diagnosis history and optimize diagnosis order on your encounters to ensure that all applicable disease bands are reported.

The four major items most contracts require are Timeliness, Accuracy, Completeness, and Remediation. We can help you build the operational reporting needed to track these and other metrics. In order to fully meet your contract’s requirements, you have to know where the status of these metrics stand each and every day.

CONTRACT COMPLIANCE

Don’t be hit with liquidated damages, or worse. As Medicaid Managed Care contracts become more and more strict, it is critical that your plan be able to deliver on their obligations related to encounter reporting. Learn how we can help.


(Hover over image for more info)

DELEGATED VENDORS

If you delegate claims payment to another entity for services such as vision, transportation, dental, and more, are you sure that those vendors are fully and completely reporting their encounter data? Learn how we can help.


(Hover over image for more info)

You need to be assured that your vendors are providing you all the encounter data necessary, and in a manner that meets the specific state requirements. We can help build reconciliation processes that let you know what is received, what should have been received, and where the problems that need attention are located. We can also help you develop the standard terms for vendor contracts that hold them accountable for full and accurate encounter reporting.