Risk Adjustment Solution Edifecs

Encounter Submissions

Ensuring accuracy of risk-adjusted revenue data and remaining compliant with submissions-related encounter guidelines are common challenges for managed care plans. And if that’s not enough, managed care plans also have to navigate frequent changes to regulatory requirements, state-specific nuances, and the complexities of using multiple submission systems.

Edifecs Encounter Submissions is a best-in-class SaaS-based solution designed to help plans overcome these challenges. Our solution utilizes AI-enabled coding and analytics to break down encounter operations silos, support submission accuracy, and ensure compliance across all managed care lines of business.

Managing Multiple Vendors is a Headache. Edifecs is the Cure.

Find out how we can help you streamline your encounter submissions.

Risk Adjustment Solution 1
  • Eliminate poor-quality data with up-front data validation
  • Streamline MAO-002 and MAO-004 reconciliation
  • Reduce submission of incomplete encounter data

Get more from your data

Maximize data quality and accuracy for more effective submission operations.

HCC Risk Adjustment 2
  • Maximize first pass rates with flexible business rules
  • Report and track SLA performance with comprehensive dashboards
  • Easily correct errors and resubmit data with bulk correction capabilities

Meet your revenue goals

Ensure accurate payments for submitted encounters.

Risk Adjustment in Healthcare 3
  • Adapt to state-specific guideline changes with automatic updates
  • Minimize audit exposure while maximizing performance
  • Facilitate continuous compliance with automated monitoring

Minimize financial risks

Enable automatic, ongoing compliance with CMS and state requirements.

News & Insights

Encounter Submissions for Medicare Advantage Organizations (MAOs)
As Medicare Advantage enrollment grows, MAO encounter processing sophistication needs to grow in kind. A scalable, business-rule and workflow driven solution will enhance submission accuracy, completeness and timeliness at a reduced cost and streamline the correction and reconciliation processes.
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Encounter Submissions for ACA Marketplace Health Plans
Accuracy, completeness and timeliness are the pillars of successful encounter submissions programs. Learn how Edifecs makes that possible for ACA participating health plans, leading to 99%+ acceptances rates.
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Webinar On-Demand: Medi-Cal Encounter Submissions Made Easy
Watch this webinar to learn how Edifecs partners with plans to deliver a best-in-class California MCP encounter submission solution.
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