Cirdan provides data services support to health plans. We are experts in working with enrollment, revenue, claim, and encounter data.
Health plans in Medicare and Medicaid are subject to extensive and complex encounter data requirements. We monitor all regulatory guidance and communications regarding encounter data requirements and promptly implement needed changes.
Encounter Data Submissions
Cirdan manages Medicare and Medicaid encounter data submissions for clients using a proprietary Business Process Outsourcing (BPO) Model. For Medicare, we also submit RAPS data. We provide Medicare submission clients with precise coordination of risk score results for the encounter and RAPS data sources.
Our process is different from the typical Software as a Service (SaaS) model. We use data from both submitted claim records and claim extracts while avoiding workarounds that create inconsistencies with the data reported and clients’ claims systems. This approach results in accurate encounter data with low error rates – with better long-term sustainability than SaaS model vendors.
Encounter Data Oversight
The Cirdan Encounter Analysis and Oversight (EAO) web tool provides health plans with an effective way to monitor their encounter data program and gain deeper insights. The EAO web tool:
- Uses dashboard indicators that quickly show program performance, trends, backlogs, 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, enrollment, and encounter data managers and their staff.
- Is available to encounter data submission clients and as a stand-alone product.
We use the EAO tool for our encounter data submission clients. We also offer it on a stand-alone basis to provide plans an analytic tool to use to monitor submission success and quality.
Risk Score Accuracy and Completeness
The Cirdan Risk Score Accuracy (RSA) report suite focuses on improving the accuracy and completeness of diagnosis data used in risk score models. The Cirdan RSA reports apply the CMS-HCC model for Medicare (Part C) and other models for state Medicaid programs. Our clients use the Cirdan RSA reports to identify priority candidates for clinical chart review, member outreach, and other targeted activities to improve the accuracy and completeness of diagnostic data recorded in claims and submitted through encounter data and RAPS. The RSA report suite includes
- Target member lists by period and program for focused chart auditing and outreach.
- Summary reports that provide diagnostic and service history for targeted members to help identify their current situation and ensure accurate diagnostic information is recorded.
- Tracking reports that identify diagnostic data corrections that need further action, facilitate information sharing, and highlight progress and accomplishments.
- Clinic profiling reports that highlight outlier coding patterns as potential priorities for follow-up, dialogue, and technical assistance.
Cirdan’s CEER (Cirdan Enrollee Experience Reports) tool is a reporting utility that provides a comprehensive view of an organization’s financial and utilization history. CEER’s features include:
- Data can be filtered by program, eligibility, service, age, and other variables.
- CEER provides the ability to gain deeper insights by switching from summary to detailed data.
- Reports are customizable. Basic reports include Loss Ratio, Experience by Rate Cell, and Revenue Summary.
- Utilization Reports in CEER break utilization down by type of service, cost per service, and monthly cost per member.