A Comprehensive Encounter Data Processing System
Wipro’s Encounter Data Processing System (EDPS) assists Plans in
submitting accurate encounter data to the Centers for Medicare and Medicaid
(CMS). EDPS is a CMS and HIPAA-compliant processing solution that manages
front-end testing, end-to-end testing and certi cation logistics. EDPS receives
the les, transforms the data, and transmits complete and compliant 5010
encounters to CMS.
Wipro offers this solution to Plans looking for assistance in any of the
following areas:
- Converting claims data to HIPAA Outbound X12 837 (5010 format)
- Encounter correction and resubmission to CMS
- Reconciliation between RAPS and Encounters
Wipro’s Encounter Correction and Resubmission system allows plans to perform
correction of encounter data and to resubmit outside their claim processing
system.
Leveraging Wipro’s RAPS-Expert, RA-Expert, and Recon+ systems, Wipro also
provides a service which reconciles RAPS HCCs and encounter submissions. Claims
data is transformed and formatted into RAPS.
Wipro takes a standardized, cost-effective pricing approach that
includes:
- Use of Software and System
- Custom Extracts to work ow
- IBM Product Licensing
- CMS-mandated System Changes
- Data storage, backup, disaster recovery and security on mainframe and
servers
- Production support and system maintenance
- Standard system user documentation and training
- Proven data-mapping expertise
How will EDPS benefit your plan?
- 5010 Encounters are created, edited and transformed by Wipro
- Encounters are transmitted to CMS accurately formatted and on time
- Reduces errors and rework
- Controls and reduces staf ng costs
Solution Highlights
Software as a Service (SaaS) Delivery
- No hardware, software, or installation required on the customer side
- Fast implementation timeframes
- Utilizes customer proprietary claim formats
- Data storage for both inbound and outbound les and reports
- Standard reports and extracts furnished to client
- Query, decode and correct errors via online system
Reliable Technology
- Average response Time < 3 seconds
- Security (SSL, HTTPS, Application security on Web Server/Mainframe)
- Secure FTP, site-to-site VPN; Worldwide accessibility
- Leverages the value of legacy systems; Error Management System
- X12 4010/5010 and IBM WTX ETL experience for encounter data
- Maps inbound claim and adjudication data
- Maps customer claim formats to 5010 loops/segments
- Tracks and reports submission statistics and drill down capable via
dashboard
CMS Compliance
- Compliance checker adds CMS and HIPAA edits/logic to ensure accepted
transactions
- Creates custom extracts of CMS responses, identifying named errors in
plain language for correction
- Uses existing claim formats and transforms through an ETL process to
produce CMS-compliant outbound 5010 encounters
- Complies with EDPS mandated deadlines and regulations
- Complies with industry and regulatory standards for exchange of complex
data
- Leverages industry standard ETL Products to produce 5010 x12 claim
encounters
- Can be configured to comply with Duals requirements
