Encounter Data Reporting

Accurate and efficient Encounter Data Processing

VisibilEDI’s Encounter Data Processing System (EDPS) enables clients to efficiently report encounter claims and payment transactions to CMS and state Medicaid programs. Our state-of-the-art system captures all responses and provides feedback and reporting tools to equip our customers with the ability to streamline their data processing for encounter management and facilitate contract compliance.

Primary Drivers

  • A single integrated encounter data management of all state Medicaid, Duals and MAO lines of business
  • Cost reduction over complex internal EDI solutions – eliminating development and maintenance
  • Evaluate your encounter data submissions with risk scores, KPI’s and incentive pool metrics
  • Simplify encounter data management through online repository with dashboard reporting
  • Decrease submission errors and exceptions, reducing time and effort
  • Reduce cost and effort to achieve HIPAA compliance while increasing overall performance

Encounter Data Processing System (EDPS) Capabilities

  • CMS and HIPAA-compliant processing solution with expertise and rules to validate data aligned to Medicaid and Medicare Advantage
  • Reporting and aligned analytics to optimize incentive metrics, risk scores and KPI’s
  • Easily visualize and manage your workflow submittal process through to remediation and acceptance
  • Quick system implementation for managing encounter data reporting and incorporating errors and rejections to improve EDPS, RAPS and Medicaid encounter processing
  • Ability to apply business rules to route, validate, fill, audit, reject/drop, integrate, and manage individual and batch level claim transactions with corresponding trading partner rejection and acceptance responses from 999, 277CA, and proprietary reporting (e.g. MAO Reports) formats
  • Dedicated portal for full management, remediation, and reporting of all transaction activity
  • Designed for business analysts to simplify management of incomplete data and rejected transactions
  • Eliminates need for expensive Healthcare EDI transaction professionals to manage 837, 835, 999, 277 and proprietary formatted transactions with trading partners
  • More efficient and less expensive than developing internal solution or black-box type outsourced services with no transaction visibility