CMS Compliant Encounter Processing & Risk Adjustment
Data Driven, Scalable & Intelligent SaaS Platform
Schedule a DemoMedAdvantage360
EDPS-GT360
- HIPAA Compliance Checker
- Interactive web portal and Dashboard
- Maximize Reimbursements
- Realtime Encounter Data Reporting
- Chart Review Generation and Submissions to CMS
Wipro's Encounter Data Processing System (EDPS) helps maximize reimbursement, reduce administrative costs, improve accuracy, 100% compliant with CMS and gain valuable insight into Encounter data.
EDPS is a HIPAA compliant processing solution that receives, transforms, and transmits complete, accurate, consistent and compliant Encounters within defined time limits. The response transactions are automatically applied and made available in Wipro's modular SaaS web platform.
EDPS integrates and processes the encounter files in various formats, performs seven levels of compliance checks through integration with Wipro's analytical platform. It provides in-depth reporting and tracking, and analysis capabilities on financial, and other critical measures.
Medicare Advantage organizations can leverage Wipro's EDPS system to improved insight, decision-making capability and strengthen financial performance.
Powerful, Intuitive and Reliable EDPS Solution
Lives Supported
Active Customers
Encounter Submissions per annum
EDPS-GT360
A Comprehensive Encounter Data Processing System
Flexible Inbound File Format
837 5010 X12 and proprietary data sources converted to HIPAA compliant CMS Outbound 837 X12 files
HIPAA Compliance Checker
Provides HIPAA compliance, additional compliance edits, error analysis, corrections, and re-submission of the rejected encounters to CMS
Interactive Dashboard
Comprehensive dashboard featuring real-time submission performance, encounter counts and current status
Hosted Environment
Data storage for all inbound and outbound encounter data files and CMS response files
Chart Review Data Processing & Reconciliation
Processing of linked and un-linked supplemental encounters for submission to CMS
Audit Preparedness
In-depth reporting, tracking and analytic capabilities for reconciliation process and mitigation of risk exposure
CMS Partnership since 1986
99.9% CMS Compliant Solution
Maximize Reimbursement
100% compliant Encounter data submission to CMS for services provided to Medicare beneficiaries
Improve Accuracy
Reduce number of rejected encounter by leveraging Wipro compliance checker, a pre submission verification engine
Increase Efficiency
Automate encounter submission with flexible inbound file formats and transcribe into CMS compliant format (837 v5010)
Valuable Data Insight
Identify HCC opportunities based on CMS models, chart data and comparing compliance edits with various files
Reduce Cost
Integrated solution with Medicare Advantage/ Medicare Medicaid Plans within one UI. Ensures more efficiency and flexibility
Minimize Risk
Minimize RAPS errors by preparing, processing, reviewing and reconciling data from Risk Adjustment Processing System
Risk stratification and predictive model using CMS HCC model
In order for CMS to accurately compute risk score and payments, Health Plans are required to submit multiple data sources including Member information, RAPS, and Encounters.
Significant changes to the HCC Risk Adjustment model, Diagnosis Code Models, and Submission methods were made. The Wipro solution helps maximize CMS payments for Health plans