Encounter Submissions

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Encounter Data System

CMS' Encounter Data System (EDS) contains far more data and is more complicated than the former RAPs system. This volume and complexity results in more opportunity for errors, exceptions and rejects of submitted diagnosis codes. Reveleer has developed our EDS Solution for Medicare Advantage plans to manage the risk adjustment process. The ultimate goal of a Medicare Advantage Plan is to remain compliant. The nature of EDS means it is more important than ever to closely watch data sent to CMS and have a clear method of managing the entire process to reach that goal, during parallel submission and beyond.

Flexible Input

  • Accepts inputs of 837 v5010, v4010, chart review data as well as custom data sources
  • Automates file processing with email notifications and alerts
  • Automated lookups correct and normalize data where possible

Tested Output

  • 837 v5010 Output to CMS
  • Reveleer takes care of all testing and certification

Resolve, Report, and Reconcile

  • Clear up the torrent of rejections inbound from CMS
  • Automatically classify CMS rejections by type – data format errors – data completeness errors – diagnosis rejections, etc.
  • Concentrate resolution efforts on rejections related to risk adjustment
  • Compare results to RAPS output to be sure risk is properly reflected