Protect Your Risk Scores

RAPS Submissions and EDPS Submission
CMS is sun-setting the current RAPS process for Medicare Advantage Risk Adjustment and replacing it with the Encounter Data Processing System (EDPS). Not only does the 837 v 5010 EDI transaction that will be used as a part of EDPS have far more data than the current RAPS format, but it is much more complicated. This volume and complexity results in more opportunity for errors, exceptions and rejects of submitted diagnosis codes. Dynamic has developed the Voyager EDPS 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 EDPS 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.

Dynamic’s dedicated resources ensure your transition to EDPS happens on time and within budget, enabling your Plan to be compliant.

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RAPS Management Features

      • Utilize a user defined work flow rule library
      • Reconcile RAPS and EDPS reply files with submission files to the encounter level
      • Submit all RAPS and EDPS data to CMS for Parts A/B/D
      • Track aging and provide management reports for data sourcing, uploading and reconciliation with CMS
      • Submission of encounter and alternate ICD codes in RAPS and EDPS format to CMS
      • Validate and edit RAPS and EDPS data before submission
      • Search and correct rejected RAPS and EDPS data
      • Resubmit corrected RAPS and EDPS data to CMS
      • Process RAPS and EDPS reply files
      • Import encounter data from legacy claims system
      • Import member data from legacy system
      • Import provider data from legacy system
      • Manual entry of RAPS data
      • Mass data correction tools
      • Inventory management dashboard
      • Log queries and make data entry/modification
      • Utilize user defined validation rule library

Encounter Data Processing Features

 

Flexible Input

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

 

Tested Output

      • 837 v5010 Output to CMS
      • Dynamic 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