Medicare Encounter Data Submissions and Consulting

At Cirdan, we believe CMS will continue to increase the weight on Encounter Data to determine risk adjusted payments. Risk scores calculated using encounter data are significantly lower for many plans. Is your plan prepared for the transition from RAPS to EDS data?

Through firsthand client experience, we know a RAPS focused process will not ensure accurate long-term risk scores. It is not uncommon for health plans to purchase an encounter submissions software solution thinking that technology alone will be the answer. Unlike most alternative vendor’s solutions, Cirdan views encounter data submissions as an integral extension of the claims processing cycle. Our solution keeps your submission data in sync with your claims, enrollment, and provider systems.

Our client’s results demonstrate that the combination of our professional consulting services along with our proprietary software tools leads to superior Encounter Data submission results:

• RAPs and Encounter Data risk scores virtually match
• Error rates significantly below industry averages
• Root cause identification and resolution
• Compliance risks mitigated

Our comprehensive Encounter Data offering:

• Business process assessment and consulting
• Cirdan web based tool for submission management & audit
• Full-service client submissions