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The latest healthcare topics from a trusted, proven, and unbiased source.


EDGE Server Data Submissions: Do You Need Help?


By Bryan Briegel/Thursday, July 7, 2016



Now that health plans have a couple of years of EDGE server data submissions under their belts, it’s a great time to step back and evaluate how your organization did.

We think a few key questions to ask are:

  • How well did our approach to EDGE work?
  • Did we have clean data to optimize our risk adjustment?
  • Were we able to respond to the changes in CMS requirements in a timely and effective manner?
  • What operational improvements do we need to make?

  • The fact is, many health plans — busy serving their members by providing quality care at a reasonable cost — simply don’t have the proper resources or experience in place to complete the arduous tasks needed to comply with the Premium Stabilization Programs. The EDGE server requirements are challenging — and missteps in meeting them have led to disappointing results, including leaving reinsurance dollars and understated risk scores on the table . Even large health plans with corporate supports in place have been challenged to meet the requirements.

If you think there’s a potential for improvement, now is the time to consider a new plan for your EDGE server submissions. Should you continue to go it alone or stick with your current TPA? Before you decide, consider all the things that a proper EDGE server process should entail.

Your solution should give you:

  • On-time, accurate submissions
  • Dynamic data management services, with constant updating to meet CMS changes
  • At a minimum, quarterly analytic reporting
  • Support staff to keep current with CMS changes and respond to their EDGE server inquiries and mandated server updates
  • Peace of mind and the ability to focus internal resources  attending to your day-to-day responsibilities

If complying with CMS’s EDGE server requirements is taxing your organization’s resources, it’s time to consider partnering with a qualified EDGE server administrator, so you can get back to the business of offering quality health care. Contact us to learn more.


Bryan Briegel, Healthcare Reform Solutions Specialist 
Anita Nair-Hartman, Senior Vice President, Payer Strategy and Business Operations



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