Simple Success Science: How One MAO Mastered Medicare Advantage Encounter Management

Simple Success Science: How One MAO Mastered Medicare Advantage Encounter Management

The RAPS to EDPS transition continues to be a major challenge for Medicare Advantage Organizations (MAOs). Moreover, with a 75/25 RAPS to EDPS split for 2019, it appears MAOs will have to contend with this dual-format submission challenge for the foreseeable future. It is important during this disruptive transition to mitigate other challenges like siloed submission systems, non-existent workflows and lack of visibility that can lead to reduced first-pass rates, increased administrative costs, inaccurate risk adjustment scoring and overall reduced revenue integrity.

In this case study, learn how a large, regional MAO was able to leverage Edifecs Encounter Management to integrate their RAPS and EDPS processes, reduce errors and improve submission accuracy.

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Edifecs Inc. is a global healthcare software company committed to improving outcomes, reducing costs, and elevating the value of healthcare for everyone. Edifecs delivers the industry’s premier IT partnership platform to providers, insurers, pharmacy benefit management companies, and other trading partners. By mobilizing its leading solutions at the front end of the healthcare information pipeline, Edifecs provides a unified platform for partners to flexibly pilot and scale new initiatives using their existing enterprise systems. Since 1996, hundreds of healthcare customers have relied on Edifecs partnership solutions to future-proof their leading initiatives in the midst of a dynamic healthcare landscape. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.