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