Manage the end-to-end encounter submission lifecycle, for all managed care programs, through a single platform.
Edifecs Encounter Management delivers a consolidated platform that ensures the accuracy, completeness and timeliness of encounter data submissions across all managed care programs and lines of business. Health plans are able to manage all aspects of RAPS/EDPS submission and reconciliation, state-specific Medicaid encounters, dual eligibles and the Marketplace (via the Edge Server) without the IT cost and complexity of operating multiple systems. Integrated exception management workflows enable the rapid correction and re-submission of rejected encounters. A flexible architecture ensures that the platform can scale to meet evolving health plan needs.
Enable a single encounter management platform for all LOBs.
Improve first-pass submission rates and reduce encounter exceptions.
Ensure encounter data submission completeness and SLA adherence.