Streamline Encounter Claim Data
Ensure systematic processing of error management, interpretation, and reconciliation
Disparate encounter systems and manual processes constantly challenge health plans. Such challenges cause reduced scalability, increased costs, financial penalties and lower risk-adjusted revenue. To overcome these challenges, we offer a singular encounter management platform. The platform spans all managed care lines of business. In addition, it scales and fits the business needs and works to ensure complete revenue integrity. What you get is, industry leading design, encounter claim data processing dashboard, error management workflow, duplicate claim submission logic and more.
Our consolidated platform ensures the accuracy, completeness and timeliness of encounter data submissions across all managed care programs. Without the IT cost and complexity of operating multiple systems, it can manage all aspects of RAPS/EDPS submission and reconciliation, state-specific Medicaid encounters, dual eligibles and the Marketplace (via the Edge Server). Rejected encounters are swiftly and accurately routed to the appropriate team members with integrated exception management workflows. Services for this purpose include best-in class hosting, which ensures performance is never sacrificed along your program’s journey towards
Systematically replace historical, identical claim data and actively process the current version to minimize multiple submissions of the same claim and manage duplicate claim data. In addition, reduce inaccurate submissions through our pre-submission gate validation analytics and insights to identify errors, directing resolution through clear and logical gates. Finally, our team of experts provides custom analytics to help you navigate ambiguous guidelines. Minimize interruptions and rework by leveraging our proactive, throughput focused support.