Ensuring Complete, Timely, and Accurate Encounter Submissions

Ensuring accuracy of encounter data is crucial to ensuring risk-adjusted revenue integrity and maximizing submission accuracy and first-pass rates. However, this can be difficult to do when state and CMS submission requirements are constantly changing—especially if an organization doesn’t have the right technology infrastructure in place.

One managed care organization (MCO) had effectively managed encounter data for more than 2 million members for years through manual workflows that relied on a patchwork assortment of in-house solutions. Although the plan had consistently met SLA expectations for completeness, timeliness, and accuracy of its encounter submissions across all lines of business, they needed to streamline their encounter operations. That’s where we came in.

In this case study, we outline the challenges affecting our customer and many other health plans like it and share how Edifecs Encounter Management helped them overcome those challenges. Specifically, we discuss how our encounter submissions solution helped our customer:

• Easily configure data to align with market-specific requirements
• Maximize encounter submission accuracy and first-pass rates
• Ensure ongoing compliance with CMS and state guidelines
• Lower costs and improve overall risk-adjusted revenue integrity

Download your free copy, and get in touch with us to learn how Edifecs can support your organization’s encounter submissions process.