As a health plan operating in the government market, you’re well-familiar with the challenges of risk adjustment — like the ongoing RAPS-to-EDPS transition, introduction of the EDGE server for ACA and changing regulatory requirements, to name a few. Addressing these issues has resulted in patched-together point solutions that leave you vulnerable to errors, compliance headaches and lost revenue.

EDPS/RAPS

Between demystifying CMS responses and performing EDPS-to-RAPS reconciliations, Medicare Advantage plans face an uphill trudge when it comes to submitting encounters. This is compounded by an inability to correct and resend submissions, which can lead to substantial revenue loss.

We have firsthand experience with the complexities of dual CMS submissions. That’s why we created a tool that helps you managerisk adjustment submissions with never-before ease and efficiency.

Your RAPS/EDPS Submission Control Center

From data import to error correction, Babel Health gives you hands-on control of the encounter data submission process — start to finish. With our R3 Insight® tool, you can identify and prioritize claims by risk, reconcile discrepancies and positively impact revenue. Even better, we provide a suite of tools that help you understand the big picture of your Medicare Advantage program performance. Streamline encounter submissions while seeing real-time risk results to support the business decisions you make every day

Babel Health offers a comprehensive Medicaid encounter data solution for both EDPS and RAPS:

  • Easily measure progress to forecasted actuarial goals
  • Define and reconcile discrepancy gaps between EDPS and RAPS
  • Rank and prioritize error correction activities by revenue amount
  • Project yearly payments by sweep
  • Analyze data, ask questions and produce reports
  • Identify trends and provider education opportunities
  • Import any file format and easily map and transform data
  • Validate data records against CMS edits prior to submission
  • Manage and quickly interpret CMS error reports

With Babel Health’s platform at your fingertips, you can easily drill down to the details, forecast results and reallocate resources accordingly. That way, you can focus your efforts where they’re needed most — on providing the best health coverage possible to our nation’s senior population.

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RAPS/EDPS Medicare & Medicare Advantage
EDGE Affordable Care Act (ACA)
Medicaid
APCD All-Player Claims Databases