Enhance encounter operational efficiency

Streamline end-to-end encounter management processes

Encounter Management for SMB

Small and mid-size managed care plans operating in Medicare Advantage and/or managed Medicaid face unique encounter management challenges. SME staffing gaps, infrastructure limitations and budgetary constraints often increase encounter data submission challenges. Overcoming these challenges requires a hosted, multi-tenant solution designed to meet the encounter data accuracy, completeness and timeliness needs of small and mid-sized managed care plans.

Our Approach

Improve first pass rate and reduce IT TCO with a tailored encounter management approach. Edifecs Encounter Management for SMB delivers market-leading capabilities to enable SLA tracking and reporting of encounter operations status, enhanced compliance with both state and CMS guidelines, intake support for multiple standard file formats and improved revenue integrity.

Capabilities

Ensure complete visibility throughout the encounter lifecycle

  • Upfront business validations to reduce encounter rejections.
  • Comprehensive adjudicated claim-to-encounter lifecycle tracking.
  • Dashboards and reports to support visibility of state submissions.

Drive down IT TCO and complexity through a standardized solution

  • Single system for Medicare Advantage and managed Medicaid lines of business.
  • 100% Edifecs-hosted and maintained encounter management system.
  • Support for multiple, standard file formats.

Improve risk-adjusted revenue accuracy

  • Increased accuracy and transparency for Medicare Advantage EDPS and RAPS submissions*.
  • Prioritized exception management workflows.
  • Vendor/pass through data load (pharmacy, DME, BH claims) support for managed Medicaid submissions.

 

*Reconciliation capabilities require additional functionality