DST Health Solutions Supports Transition to New CMS Encounter Data Processing System (EDPS) For Mt. Carmel Health
BIRMINGHAM, Ala., June 8, 2012 /PRNewswire/ — DST Health Solutions, LLC, today announced that Columbus, OH-based Mount Carmel Health Plan (MediGold) has achieved its professional certification for the new CMS (Center for Medicare and Medicaid Service) EDPS regulation through the use of DST’s comprehensive EDPS Solution. The new solution supports Medicare Advantage Plans in their transition from the Risk Adjustment Processing System (RAPS) to EDPS.
With the onset of CMS’ EDPS, health plans will be required to submit claims and chart review encounters using the HIPAA 837 version 5010 transaction format in conjunction with the CMS companion guides. This submission format involves many more data fields, a greater volume of data and far more edits than the current RAPS submission format. Because of this, the EDPS submission process is expected to expand the possibility of rejections and potential complications experienced by plans.
“We’ve been very successful with RAPS, but encounter data reporting is much more challenging,” said Jim Armstrong, Information Systems Director, Mount Carmel Health Plan (MediGold). “DST’s solution leverages a data store that not only is for EDPS, it also holds a copy of every inbound and outbound transaction that occurs as part of our day-to-day operations: claims, remits, chart reviews, prospective encounters, and EDPS transactions. That data store is linked to our claims adjudication system and the EDPS tool in a way that lets us pull every relevant detail into our EDPS submissions, making our EDPS data complete to a degree I didn’t think would be possible, and making me confident that CMS will have an accurate picture of the work we do on behalf of our members.”
DST Health Solutions (DSTHS) will moderate a panel discussion focused on EDPS transition during the Medicare Risk Revenue Management – Best Practice Operational Strategies summit, June 11, in Washington, D.C. The panel, “Implications of CMS’ EDPS Submission Process, Strategies for Protecting Your Medicare Revenue,” moderated by Teri Mullaney, DST Health Solutions Strategy Officer, will feature several health plan executives and industry analysts and will discuss the following topics regarding EDPS:
- Best practices to effectively handle data edits and rejections and manage the EDPS process from end-to-end,
- Integrated ways to quickly interpret and implement the changes required to maintain a compliant process, and
- Implications of EDPS vs. RAPS reconciliation, and revenue protection strategies.
“The transition from the RAPS to EDPS encounter submission methodology requires Medicare Advantage Organizations to prepare for a number of different scenarios that will create substantial changes within their current workflow, staffing models, and revenue projections. The transition to a new HCC code set and ICD-10 will have a great impact on these scenarios, as well,” said Mullaney. “DST has the extensive experience required to provide our clients with the technology and staffing necessary to ensure success with CMS data submissions as well as other compliance based initiatives.”
DST’s EDPS Solution helps reduce health plan resources required to meet and maintain CMS submission compliance. Through seamless integration of DST’s solution into their current workflow, health plans are able to effectively handle data edits and rejections, and manage the EDPS process from end-to-end while maintaining complete process compliance. The EDPS solution was developed specifically to follow CMS Companion Guides and rule sets, and is continually maintained by DSTHS to address any changes published by CMS.
To learn more about DST Health Solutions and its EDPS Solution, visit the DSTHS booth (#319) at AHIP (America’s Health Insurance Plans) Institute 2012, June 20-22, in Salt Lake City, or go to www.dsthealthsolutions.com.
About DST Health Solutions
DST Health Solutions, LLC delivers systems and services that help improve efficiency, increase speed to market, as well as facilitate medical cost management and price containment. Our clients include commercial health plans, consumer-directed plans, government plans (Medicare Advantage, Medicare Part D and Medicaid) and physician practices. DST Health Solutions’ enterprise applications and outsourcing services include claims processing, member and provider management, benefit plan management, new product development, care management and medical management, and decision support/analytics. DST Health Solutions is a wholly-owned subsidiary of DST Systems, Inc. For more information about DST Health Solutions, contact 800.272.4799, email firstname.lastname@example.org or visit www.dsthealthsolutions.com.
The information and comments above may include forward-looking statements respecting DST and its businesses. Such information and comments are based on DST’s views as of today, and actual actions or results could differ. There could be a number of factors affecting future actions or results, including those set forth in DST’s latest periodic financial report (Form 10-K or 10-Q) filed with the Securities and Exchange Commission. All such factors should be considered in evaluating any forward-looking comment. The Company will not update any forward-looking statements in this press release to reflect future events.
SOURCE DST Health Solutions