The San Francisco Health Plan Story:

The Drive to Continuous Encounter Compliance and Provider Reimbursement Accuracy

San Francisco Health Plan (SFHP) strives to provide high-quality medical care to the largest number of low-income San Francisco residents possible, while supporting the area’s public and community-minded providers. As part of their pursuit of quality and excellence in all operational areas, SFHP recognized a need to improve the accuracy and compliance of their encounter data submissions to the state and to ensure their capitated providers were fully reimbursed. However, they were challenged by the high ongoing cost of a home-grown encounter solution, compliance regulations enforced by the California Department of Health Care Services (DHCS) and a lack of encounter transparency and reconciliation. In this case study, learn why SFHP selected Edifecs Encounter Management to improve their processing efficiency and risk adjustment scoring accuracy, all while reducing IT TCO.