Although the future is always uncertain, there are ongoing, complex reporting requirements we know health plans must meet in 2017. EDGE server data submissions are as challenging as ever, and health plans must submit complete 2016 benefit year data by May 1, 2017.
Accurate and complete data submissions are a must to ensure that you present the actual risk of your member population and maximize your reinsurance and risk transfer payments. Was your EDGE server software stack upgraded to the new CMS requirements by January 31, 2017 – and are you feeling prepared? We think a few key questions to ask are:
- How well is our approach to EDGE working?
- Did we have clean data that optimized our risk adjustment efforts?
- Were we able to respond effectively to the ongoing changes in CMS requirements? Most recently, how has our CMS-required EDGE server re-imaging and software stack upgrade gone?
- What improvements do we need to make to maximize our return on our EDGE efforts?
The difficulties in accurately capturing and presenting your members’ risk and effectively processing EDGE data become abundantly clear when health plans receive their annual risk adjustment transfer payment reports from CMS each summer, and many are unhappy. The fact is that many health plans, busy serving their members by supporting quality care at a reasonable cost, simply don’t have the requisite resources or experience in place to complete the arduous tasks needed to comply with EDGE server data submissions. EDGE server requirements are challenging—and continue to evolve.
If you think there’s opportunity for improvement, now’s the time to consider a new direction for your 2017 benefit year submissions. Should you do it on your own? Stick with a vendor you’re not thrilled with? Before you decide, consider all the things that a proper EDGE server process should entail. Your solution should give you:
- On-time, accurate submissions
- Ongoing risk optimization services
- Data management setup and continuous data management services
- Analytic reporting
- A support staff to keep up with HHS changes and respond to EDGE server updates
- Peace of mind and the ability to focus internal resources on your day-to-day responsibilities
What Can Truven Do? Our Data Speaks for Itself.
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