RAPS Submissions

Protect Your Risk Scores

Dynamic’s Risk Adjustment Processing Systems (RAPS) solution provides Medicare Advantage health plans with a turn-key solution including customizable RAPS “Gold Standard” filtering logic supported by Dynamic’s subject matter experts. Dynamic’s comprehensive RAPS solution supports pre-submission validation, data workflows and edit capabilities to increase CMS submission acceptance while supporting insight into data sourcing, reconciliation with Encounter Data System (EDS) risk scores,  and reconciliation with CMS.

Dynamic’s RAPS solution helps health plans optimize their revenue through:

  • Data accuracy helps recover suspect or missing information to ensure optimized payments
  • Filter customization drives more accurate CMS submissions resulting in improved risk scores
  • Supplemental data submission and editing capabilities enables optimization of risk scores

Dynamic’s RAPS solution helps health plans maintain compliance through:

  • The ability to validate and edit RAPS data to minimize errors defined by CMS as avoidable rejects
  • Tracking of aging and available management reports for data sourcing, uploading, and reconciliation with CMS

Dynamic’s RAPS solution helps health plans achieve operational efficiency through:

  • Reconciliation of RAPS reply files with submission files to the encounter level vs. just file level

RAPS Key Features

  • Customizable RAPS “Gold Standard” filtering logic
  • Utilize user defined validation rule & workflow rule library
  • Validate and edit RAPS data before submission
  • Conduct CMS RAPS data submissions
  • Submission of encounter and alternate ICD codes in RAPS format to CMS
  • Track aging and provide management reports for:
    • Data sourcing
    • Uploading
    • Reconciliation with CMS
  • Process and reconcile RAPS reply files with submission files to the encounter level
  • Search and correct rejected RAPS data
    • Manual entry of RAPS data
    • Mass data correction tools
    • Resubmit corrected RAPS data to CMS
  • Log queries and make data entry/modification