Products

RAPS/Encounter Data Processing (EDPS)

Voyager’s RAPS Management Module provides the ability to:

	Utilize a user defined work flow rule library
	Reconcile RAPS reply files with submission files to the encounter level
	Submit all RAPS data to CMS for Parts A/B/D
	Track aging and provide management reports for data sourcing, uploading and reconciliation with CMS
	Submission of encounter and alternate ICD-9 codes in RAPS format to CMS
	Validate and edit RAPS data before submission
	Search and correct rejected RAPS data
	Resubmit corrected RAPS data to CMS
	Process RAPS reply files
	Import encounter data from legacy claims system
	Import Member data from legacy system
	Import Provider data from legacy system
	Manual entry of RAPS data
	Mass data correction tools
	Inventory management dashboard
	Log queries and make data entry/modification
	Utilize user defined validation rule library

EDPS
CMS is sun-setting the current RAPS process for Medicare Advantage Risk Adjustment and replacing it with the Encounter Data Processing System (EDPS). Not only does the 837 v 5010 EDI transaction that will be used as a part of EDPS have far more data than the current RAPS format, but it is much more complicated. This volume and complexity results in more opportunity for errors, exceptions and rejects of submitted diagnosis codes. Dynamic has developed the Voyager EDPS Solution for Medicare Advantage plans to manage the risk adjustment process.

Comprehensive Risk Management Tools Flexible Input
	837 v5010 Output to CMS
	Accepts inputs of 837 v5010, v4010, chart review data as well as custom data sources
	Automated lookups correct and normalize data where possible
	Other incomplete items automatically added to specific work queues for review – i.e. Member Matching/ Provider Matching
Tested Output
	837 v5010 Output to CMS
	Dynamic takes care of all testing and certification
Resolve and Report
	Clear up the torrent of rejections inbound from CMS
	Automatically classify CMS rejections by type – data format errors – data completeness errors – diagnosis rejections, etc...
	Concentrate resolution efforts on rejections related to risk adjustment
	Compare results to RAPS output to be sure risk is properly reflected