Risk submission and reconciliation should be easy.
Did you ever wonder why it’s so challenging to perform EDPS to RAPS reconciliations, or to prioritize encounter correction efforts using risk scores? So did we. It’s our experience dealing with the complexities of dual CMS submissions that drove us to create simplified, quality solutions so that Medicare Advantage health plans can easily drill down to the details, forecast results and reallocate resources accordingly. That way, you can focus your efforts where it’s needed most—on providing the best health coverage possible to our nation’s senior population.
Medicare Advantage plans require the financial acuity to balance the needs of their members with the demands of the government, while maintaining the financial strength to accomplish both tasks. In addition to being a CMS-certified submitter, Babel offers a suite of tools that provide insight into your MA program performance, including R3 Insight©, which gives you the ability to identify and prioritize claims by risk, reconcile discrepancies and positively impact revenue. From data import to acceptance and reconciliation, MA plans can manage their risk adjustment submissions with ease and efficiency, while seeing real time risk results to support the decisions they make daily.
Our fully integrated suite enables your health plan to:
- 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
- Eliminate reliance on IT resources
Take a closer look at the EDPS/RAPS dashboard
Customizable so you can see what's important to you.
Claims to Encounter Conversion
Stay informed about your MA programs encounter submission status in real time.
Claims Validation Errors
Keep apprised at a glance of the data quality challenges being worked within the program.
Encounter Acceptance Rate
Review CMS submission results and drill down to the details with a click of your mouse.