Encounter Reporting & Claims Data Management
Report encounter, claims, and enrollment data in a cost effective and efficient manner
We ensure complete, accurate, and timely reporting of ACA-Commercial, Medicare, and Managed Medicaid data, including initial submission, reconciliation, adjustments, corrections, and resubmissions. Using our expertise and leading technology applications, called ENCOUNTER Complete™ and EDGE Complete, we enable health plans to report encounter, claims, and enrollment data in a cost effective and efficient manner.
Our technology optimizes the throughput of required data, facilitating accurate and timely submissions. Its features allow healthcare organizations to submit all required data elements to contracted counter-parties such as the Centers for Medicare and Medicaid Services (CMS) for Medicare’s Encounter Data Processing System (EDPS) and ACA Edge Server and state Medicaid entities.
As a Web-based user interface, ENCOUNTER Complete and EDGE Complete are hosted and maintained by Altegra Health with virtually no burden on partner organizations’ IT departments. It is secure, flexible, and scalable, and can be accessed through any Internet portal.
- Conversion – Source data converted into the required format.
- Pre-validation Rules – Minimize response errors.
- Error Prioritization Methodology – Understand risk value and provider impact.
- Submission – Map selected items for submission, such as formatting in 837I/P version 5010 to meet CMS requirements, submits files, and posts detailed activities in the system.
- Reconciliation – Receive files returned from CMS or state Medicaid, reconcile and update statuses, and resubmit error corrections.
- Post-submission Analysis – Monitor the status of all claims and encounters that have been submitted, accepted, rejected, etc.
- Error Analysis – Identify all reason codes for errors and displays error in multiple groupings such as error type, member, and provider.
- Error Management – Assign error correction queues and manage error-correction processes.