Advalent Encounters Plus: Encounter data submission (EDS)
Flexible encounter data reporting solution delivered on speed & accuracy

Advalent’s Encounters Plus solution offers health plans, a highly configurable cloud-based solution to automate Encounter Data Submissions (EDS) to Centers for Medicare & Medicaid Services (CMS), states and commercial entities. Federal and state rules are built-in and maintained continually by Advalent to simplify your certification, compliance and submissions of clean claims. Advalent Encounter Plus, a HIPAA-compliant turnkey system simplifies the end-to-end process of the Medicaid Encounter Data Processing System (EDPS), making it easier for health plans to validate and submit full encounter data in a timely fashion that is also clean and complete.

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Submissions

Advalent Encounter Plus individual and role-based work queues help MAOs & MCOs to ensure timely and correct encounter data submission with fewer resources. The system makes it convenient to automate accurate claims submissions using configurable workflows tied to rules. Additional mapping rules and rulesets can be configured for delivery to other organizations as well.

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Compliance

Advalent Encounter Plus keeps abreast of Encounters submission guidelines and keeps the system up to date. This ensures that Advalent Encounters Plus lowers the resource requirements for your health plans to maintain CMS encounter data submission compliance.

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Integration

Advalent Encounters Plus can readily manage Healthcare data submission involving multiple incoming file formats and different receiving entities using the same tools and processes with minimal additional resources. The system supports simultaneous processing of claims for dual-enrolled Medicare-Medicaid eligible members and claims for Medicaid in multiple states.

System Usage Ease

  1. Managed Rulesets
  2. Simplified custom configuration
  3. Ability to create custom rulesets and workflows
  4. Access to work queues
  5. Appropriate queues for Exceptions review
  6. Pending tasks Notifictions
  7. Data analytics submissions performance and improvements

Data Process Ease

  1. Import claims data from multiple vendors
  2. Import claims data in different file formats
  3. Generate load and exception reports
  4. Map Claims data to Encounters data format
  5. Exception queues for individual review
  6. Exceptions queues for role-based review
  7. Submit electronic data to CMS, States and other entities

CMS Mandated Entities

  1. Medicare Advantage Organizations (MAO)
  2. Cost-Reimbursed Health Maintenance Organizations (HMO)
  3. Comprehensive Medical Plans (CMP)
  4. Health Care Pre-payment Plans (HCPP)
  5. Programs of all Inclusive Plans for the Elderly (PACE)