Risk Submissions

Seamlessly submit for all lines of business through one easy-to-use interface

Encounters Plus™/Encounters+™ is a HIPAA-compliant, cloud-based, Software as a service (SaaS) solution for RAPS, EDPS, Medicaid, EDGE and APCD risk-adjusted submissions to CMS, states and commercial entities. It accepts enrollment, medical and pharmacy claims from client-specific data sources, including multiple sources and formats, and automatically converts them to the correct file format for data submission to CMS or state entities. Dashboards and reports allow plans to view submissions, make required changes and resubmit seamlessly to ensure they are getting the appropriate risk adjustment and reinsurance reimbursement. Additionally, federal and state rules are built-in and continuously maintained by Advalent to simplify certification and ensure ongoing compliance. Encounters Plus™ makes it easier than ever for health plans to submit clean data, correct errors and provide real-time reporting. We leverage the experience of our core team of healthcare experts to provide health plans with business management consulting and advisory services that drive results.

custom submission
Key Features:
  • Data Management – Powered by a robust, EDI rules-based, workflow gateway, Encounters Plus™/Encounters+™ supports both inbound and outbound data validation through electronic data interchange services, production workflows for error correction, reporting and alerts and risk adjusted revenue forecasting. The engine can be configured to auto sweep, load and run post-submission validations and projections for both inbound data and state and CMS generated return files. Additionally, it is designed to support the new FHIR interoperability for EMRs in conjunction with Advalent’s Risk360’s MRR and Smart NLP Coding and Abstraction solution.
  • Error Administration – Supports pre- and post-submission error correction for individual, mass and automated error correction. With rules-based workflows, errors can be mass corrected or forwarded to staff for individual error interventions based on configured compliance rules. Encounters Plus™/Encounters+™ can be integrated with source systems to automatically pass updates through or configured to create a load file for manual review and loading.
  • Business Intelligence Driven Reporting – Encounters Plus™/Encounters+™ is pre-configured with many editable reports based on the submission model and is powered by a matured BI platform, which allows for real time data visualizations, production ready dashboards which illustrate loading, validation and revenue forecasting. The open architecture database gives plans the ability to utilize their own reporting solution.
  • Risk Model Flexibility – Supports CMS-HCC, CDPS, ACG and 3M CRG Risk Adjusted and other known or custom algorithms for data management and encounter submissions in one platform.