Streamline Encounter Lifecycle Operations

Improve Encounter Accuracy & Completeness

Encounter Data Accuracy

It is mission-critical for State Medicaid Agencies (SMAs) to ensure they are receiving complete and accurate encounter data submissions from their health plan partners so that they, in turn can provide this information to CMS. Many challenges exist, however, including the fact that states have simply struggled, historically, to collect complete and accurate encounter data from managed care health plans.

Our Solution

Overcoming SMA encounter challenges requires a comprehensive, purpose-built solution. Edifecs Encounter Management features “Straight-Through Encounter Processing” that helps State Medicaid Agencies handle the complexities of encounter submissions for both state-specific as well as CMS submissions. Built to ensure TMSIS compliance and enhance encounter data accuracy, our solution delivers unsurpassed, market-validated capabilities for the state market.

Capabilities

Improve encounter data submission accuracy

Reduce rejects and improve SLA adherence for MCO plan partners.

  • Maintain history of rejected encounters and track data quality metrics.
  • Dashboards to manage and monitor SLAs and performance of individual MCOs.
  • MCO and state administrator self -service capabilities for error tracking & root cause analysis.

Efficiently manage encounter intake and reporting

Singular platform supporting Straight Through Encounter.

  • Processing (STEP) from MCOs to TMSIS.
  • State specific knowledge packs included enabling state specific edits.
  • Consolidated encounter book of record.
  • Identify and close coding gaps from MCOs.
  • Track the lifecycle across encounter submissions.

Deliver quality submissions and reduce re-work

Enhance encounter data quality while reducing administrative costs and complexity.

  • Pre-built validation rules based on T-MSIS data quality checks.
  • Dashboards providing visibility into data quality issues.
  • Reduce CMS-levied penalties.