The health plan was contracted to a third party for their submissions but they were growing dissatisfied with their vendor’s lack of flexibility to make customizations to the platform and execute them in a timely manner. The plan knew that greater insight into their data and control over the process was necessary. They required accurate and compliant submissions as well as a customer service team who was accessible and could quickly adapt. “We wanted more transparency and better support [for] what was going on with our records and our submissions to CMS,” said the plan’s Encounter Analysis Manager.
The Challenges:
Download the case study to learn more about Episource’s approach and the solutions that were implemented to drive results for this large Puerto-Rican based Medicare Advantage health plan.
Episource and ProMedica discuss their risk adjustment solutions for lowering compliance risk.
The transition from RAPS to the EDS for calculating Medicare Advantage risk scores, payer organizations should have a plan to minimize system errors.
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