Supporting Your EDGE Server Regulatory Needs

Health Plans joining the Health Care Exchange (Marketplace) in 2014 will have to comply with Health and Human Services' (HHS) three "R's": risk adjustment, reinsurance, risk corridors. Although, reinsurance and risk corridors is temporary and important, Risk Adjustment in Health Care Exchange will be a crucial piece to identifying the health plan's member population and determining payment transfer between health plans. At Reveleer, we will work with health plans to extract and transform your proprietary data into HHS compliant files. We store all submissions and responses and provide solutions to analyze your data that can help identify gaps in care, high risk members, and even have the capabilities to support your ACA EDGE Server needs. We will stand up your system and work with HHS to provision your servers, manage and host the servers, and submit and retrieve all files to/from HHS.

Features

• Extract, transform and load data in various formats and locations into a normalized data repository
• Store, track and status submissions, response data and error corrections
• Supports data privacy requirements (i.e. beneficiary ID masking and external cross referencing)
• The entire data processing chassis supports automated intake, export, and reconciliation processing
• Submit required data in standard file formats
• Import and process standard reply files
• Track data correction and trigger resubmission
• Reconcile all submission and response files
• Host or contract a third party to host a physical edge server, provisioned with the required government data processing software
• Reveleer provides coordination between CMS and the edge server for maintenance and upgrades