Submissions

This solution helps end multi-vendor management headaches, leverages AI-enabled coding automation with integrated submission compliance and analytics tools, breaks down encounter operations silos, and ensures compliance and risk adjustment accuracy across all managed care lines of business.

Managed care plans of all types struggle with managing the accuracy of risk-adjusted revenue data and with conforming to submission-related encounter guidelines. These issues are compounded by constantly changing regulations, State-specific nuances and the use of multiple submission systems. Overcoming these challenges requires a best-in-class encounter submission platform backed by NLP-enabled operations and analytics. Edifecs delivers the industry’s most complete suite of risk adjustment solutions, by powering managed care plans' success across lines of business.

Infographic - Encounter Submissions

Features

Streamline Regulatory Compliance

  • Enable continuous compliance-monitoring based on changes to the HHS-Developed Risk Adjustment Model Algorithm
  • Best-in-class regulatory change management

Ensure your submissions remain compliant with constantly changing CMS and State rules

Improve Risk-Adjusted Revenue Accuracy

  • Enable prospective risk adjustment analytics for direct Provider support in clinical settings
  • Leverage HCC-prioritized exception workflows, backed by AI/ML technology
  • Implement flexible business rules to improve first pass rates

Accelerate the attainment of accurate and compliant risk-adjusted revenue

Reduce Audit Exposure

  • Deploy a comprehensive solution to streamline MAO-002 and MAO-004 reconciliation
  • Reduce the submission of unlinked chart reviews
  • Enable up-front data validation to prevent the introduction of poor-quality data

Ensure your submission operations reduce audit exposure while supporting RADV and IVA performance

Decrease State Penalties

  • Utilize dashboards to report and track SLA performance
  • Enable mass correction capabilities to fix errors and resubmit data
  • Leverage Edifecs-managed module updates based on State-specific changes

Drive continuous compliance to meet constantly changing State requirements.