Achieving Business Scalability with 99% Acceptance Rates

NAMM California works as a delegated model, contracting with health plans to manage risk associated with delivering healthcare services. It is responsible for managing member care as well as running back office operations such as adjudicating claims and sending encounter data directly to the insurer. To gain additional processing efficiencies and manage the increasing number of submissions, NAMM California sought an encounter management solution partner with end-to-end tracking and analysis capabilities that could assist in onboarding new health plan organizations.

Using the Edifecs Encounter Management solution, NAMM California has been able to share cleaner encounter data with their trading partners, resulting in significantly fewer rejections. The team has increased first pass acceptance rates, submitted millions of transactions, and increased its overall acceptance rate to over 99.9%.

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