An encounter claims data analytics platform for payers that want flexibility to handle systematic processing of error management, interpretation, and reconciliation to meet revenue goals.
What’s included in Encounter Complete™
Industry leading design
- Leverage a team experienced in CMS duals and MMP submissions
- Among first certified EDPS vendors submitting encountered data to Medicaid, Medicare, and ACA since 2000 for more than 4 million lives
- Get help navigating ambiguous guidelines through regular CMS and state interactions
- Minimize client interruptions and rework
- Gain program management expertise and data implementation services
- Focus on submission quality and volume
Encounter claim data processing dashboard
- Quickly confirm monthly file sets were successfully received and processed
- Ensure error rates are within expectations
- Gain a clear understanding of gate error, accepted, and rejected rates with risk adjustment opportunity insights
- Help ensure you meet the 95% accuracy CMS requirement, helping increase payouts
- Help reduce inaccurate submissions with proprietary pre-submission gate validation analytics and insights
Error management workflow
- Review the information needed to prioritize correction efforts
- Use Error-mix List to maximize resources to help contribute to highest risk adjustment impact
- Show the errors impacting claims and the associated potential value
- Allow your team to understand progress on specific error codes with error correction statistics
- Help users monitor error remediation
- Get a summary view scorecard of error status and associated claims
- Manage error correction and re-submission for top error-mix opportunities through systematic plan remediation efforts
Duplicate claim submission logic
- Overcome duplicate submission challenges with Encounter Complete logic
- Submit replacement claims for claims that are voided and not accepted
- Reconcile split claim lines by systematic aggregation of all claim services into encounter lines according to defined counterparty service duplication rules
- Replace historical versions of a claim and actively process the current version by accepting and linking unique claim ID mnemonics or patterns through process methodology
Streamlineencounter claim data throughout
Validation to meet complex requirements
Automate and validate inbound file and counterparty processing to reconcile data that requires significant transformation to meet complex and varying file requirements for different encounter claim types.
Innovative technology to reduce inaccuracies and duplicates
Reduce inaccurate submissions through our pre-submission gate validation analytics and insights to identify errors, directing resolution through clear and logical gates. Manage duplicate encounter claim data by systematically replacing historical, identical claim data, and actively processing the current version to minimize multiple submissions of the same claim.
Engaged support to increase productivity
Help minimize interruptions and rework by leveraging expert custom analytics support from our proactive, throughput focused Program Management team that helps you navigate ambiguous guidelines. Analyze error mix and processing results to prioritize errors by using multiple filter and group-by options to help meet rigid error correction deadlines.
Need support for
- Dx Gap Advisor™ Learn how our analytics-driven risk adjustment review solution helps to support diagnosis coding accuracy, streamline billing workflow, and close risk gaps. Learn more
- Edge Complete™ Learn how our data lifecycle claim management solution helps meet ACA Edge Server requirements with streamlined workflows, status reporting, and timely delivery. Learn more
- Risk View™ Discover how our risk adjustment software platform helps healthcare insurers understand risk score trends and opportunities for appropriate risk-adjusted reimbursement. Learn more
Join Community discussions
Find and share knowledge, exchange ideas, and collaborate with peers and Change Healthcare experts to drive your solutions to success.