Wipro’s Encounter Data Processing System (EDPS) assists Health Plans in submitting Medicare Advantage, Managed Medicaid, and Dual Demonstration encounter data to the Centers for Medicare and Medicaid (CMS), and States. EDPS is a CMS and HIPAA* compliant processing solution that manages front-end testing, end-to-end testing, and certification logistics. EDPS receives, transforms, and transmits complete and compliant encounters. The response transactions are automatically applied and made available in Wipro’s proprietary SaaS web portal.
Wipro offers this solution to Health Plans looking for assistance in either conversion of claims data to HIPAA Outbound X12 837 (5010 format), encounter correction and resubmission to CMS or reconciliation between RAPS and encounters.
Consulting and comprehensive business services are offered for Data and error corrections, CMS guidance, integration of Vendor, Trading Partner & FDR, HCC identification and Revenue reconciliation & revenue gap identification
- Flexible Input - 837, v5010 and custom data sources
- Edit Logic - CMS- and MA-specific edit logic to meet CMS mandates
- Error Correction-One stop for all types of encounters, with a high acceptance rate
- 100% compliance -Submit data to CMS and automate manual processes
- Acceptance rate 95%+ - Best-in-class HIPAA compliance checker
- 24*7 Operations - Web portal to view all encounters (regular/chart reviews)