Cirdan was one of the earliest certified submitters of CMS Medicare data in 2012. We were also an early tester of encounter submissions, working closely with CMS to identify encounter data submission errors. Today, our submission clients enjoy exceptionally complete and accurate encounter data.
Health plans in Medicare and Medicaid must meet extensive, complex and continuously changing encounter data requirements. An effective encounter data program will help you stay compliant and provide a foundation for accurate CMS risk scores and premiums. Managing your plan’s encounter data is key to your success in the Medicare and Medicaid markets.
Cirdan follows a proprietary business outsourcing (BPO) model that integrates with our clients’ operating systems giving us a leg up over SaaS models. We use data from both submitted claim records and claim extracts while avoiding workarounds that create inconsistencies with the reported data and source data. This helps us consistently deliver accurate results and reduce errors.
Our BPO submissions process is integrated with our Cirdan Encounter Analysis and Oversight secure Web tool. The EAO web tool:
- Uses dashboard indicators that quickly show program performance, trends, and error rates.
- Is easy to implement. Implementation requires only standard submission and response files with no custom extracts needed.
- Provides deep analytics to support the needs of finance, claim, and enrollment, and encounter data managers and their staff.
Since the EAO tool gives you deeper insights into your programs, it can serve as a focal point for long-term process improvement initiatives. As you implement these initiatives, we’ll guide you on how to continually improve Medicare and Medicaid encounter data submission results.
Cirdan also uses encounter data to help clients achieve risk score accuracy and completeness. The Cirdan® Risk Score Accuracy (RSA) reporting services focus on improving the accuracy and completeness of diagnosis data used in risk score models. The RSA reporting services apply the CMS-HCC model for Medicare (Part C), and the widely used risk adjustment models for Medicaid.