Accurate submissions, optimized payment.
ikaSystems RAPS (Risk Adjustment Payment System) and EDPS (Encounter Data Processing System) solutions transform health plan data for processing and submission to the Centers for Medicare & Medicaid Services (CMS) while both optimizing revenue and lowering costs. The highly configurable, low-maintenance solutions help ensure that claim and chart review data for the RAPS and the newer EDPS are validated, processed, and submitted accurately and on time.
ikaSystems RAPS and EDPS solutions are ideal for Medicare Advantage plans seeking to comply with and adapt systems for changing CMS guidelines and to receive accurate payments. Our testing shows a minimum 95% acceptance rate on all transactions in all EDPS encounters and RAPS files and 100% effectiveness for our deduping logic.
More efficiency, flexibility
ikaSystems RAPS and EDPS solutions automate validation, processing, and reconciliation of chart review and claims data with more efficiency while ensuring adherence to CMS regulations. ikaSystems continually reviews CMS regulations and makes updates to the system to reflect them.
ikaSystems solutions help optimize Medicare revenue with content-rich workflow tools that enable you to identify errors for resolution and with robust reporting tools that display reconciliation outcomes to detect trends and project CMS payments for each member.
As your Medicare business evolves, you can easily configure the systems to update existing plans, products, and membership networks yourself—without changing any code. This flexibility significantly reduces your cost of maintenance and provides scalability to support rapid membership growth.
ikaSystems RAPS and EDPS solutions can also be integrated with any third-party solution or legacy system seamlessly—and can be automatically upgraded with little additional effort as updates become available.
The benefits speak for themselves
ikaSystems RAPS and EDPS solutions enable you to:
- Configure the frequency of data fed into ikaSystems solutions
- Validate all claims and chart review data to ensure they are correct for submission and no duplicates are submitted
- Submit RAPS and EDPS data to CMS—including multiple diagnosis codes for an encounter
- Reconcile data submitted and generate reports based on the outcome—including file and record/encounter level statistics as well as submission and rejection trends
- Create reports at every level in the file process
- Create summary-level reports showing all health plan submitted and unsubmitted reports and all CMS reports
- Get a detailed description of errors and resolve them as appropriate
- Delete and resubmit corrections on select records/encounters
- Compare claims submitted and accepted to project CMS payments
- View detailed information on all inbound and outbound files
- Access transaction history on all records/encounters
- Attain positive results on Risk Adjustment Data Validation audits
ikaSystems is certified by CMS in both RAPS processing and EDPS testing, including EDPS front-end testing and EDPS professional, institutional, and DME end-to-end testing.
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