Wipro’s RAPS product is easily tailored to fit a wide variety of customer submissions, ranging from common industry standard Claims Formats (837/1500), through direct CMS RAPS Format files, or even manual entry and maintenance of RAPS information.
RAPS Processing solution provides flagging of common enrollment timing errors held in suspense to be flagged for automatic resubmission. Also searches for outstanding enrollment issues in clients RAPS history and flags those clusters for resubmission with little or no client intervention.
Wipro’s RAPS system minimizes RAPS errors, the amount of time Plans spend preparing, processing, reviewing and reconciling RAPS data and return files. Provides preliminary qualification for acceptable risk adjustment sources.
RAPS full service provides a UI interface and claims extracts from EDPS into RAPS system for the purpose of performing acceptable source edits. Both Institutional and Professional accepted clusters will be sent to CMS (3000 clusters/file). Vendor forwards the RAPS files to Palmetto, and receives CMS return files on behalf of the client. These files are transmitted to Palmetto using a Secure FTP (encrypted) connection and the FTP response files from Palmetto are received by VENDOR over the same type of connection. Vendor holds the returns files and the client may pick them up from the VENDOR’s secure website using HTTPS Protocol or request these files to be sent to them via SFTP. Summary of accepted /rejected claims will also be provided.
MEDICARE RAPS generated standard reports and data extracts help Plans monitor trends and understand discrepancies. Reports can viewed/downloaded for analysis from the web portal
RAPS provides data extracts to help Health Plans monitor, track, reconcile, RAPS submissions and view rejected clusters for resubmission to CMS. Extracts show:
