CNSI today announced that 1 billion encounters have been successfully processed through the Encounter Data Processing System (EDPS) established for the Centers for Medicare and Medicaid Services (CMS).

As a result, CMS will achieve greater visibility of its Medicare Advantage (MA) program and will now be able to look across the entire Medicare delivery system to identify trends and make policy changes to strengthen the program for the nearly 47 million people that depend on it for their health care services. 

Through a partnership with Northrop Grumman, and over the course of only three months, CNSI developed and implemented the initial release of EDPS to manage data exchange and service interactions between different systems and applications based on federal rules. Over time, additional functionalities were also released for EDPS.

In 2012, CMS began requiring additional MA encounter data to be collected to establish risk adjustment models and compare managed care and fee for service health care costs. CNSI, as a subcontractor to Northrop Grumman, implemented its eCAMS Health Care Engine as the core component of the EDPS which will allow CMS to analyze the quality, quantity, and kinds of health care services Medicare beneficiaries receive within MA plans.

The platform improves application performance and demonstrates the ability to scale information by eliminating backlog and maintaining currency. With its ability to extract and deliver information, the latest accomplishment speaks to eCAMS’ efficiency and aptitude to handle large volumes of data sets. Today, the system adjudicates more than double the transactions on average it was capable of handling last year, at 1.8 million encounters daily. 

The solution supports operational efficiency through automated processes, offers enhanced stakeholder governance and transparency in business operations, and provides quality data output of encounter cost and utilization for the required risk adjustment models of the MA plans. 

EDPS provides CMS with the data and analytics to make “apples to apples” comparisons across its MA and Fee-for-Service (FFS) programs by performing similar edits on MA plan encounter data as those performed on FFS claims data.

Team EDPS continues to collaborate with MA Plans and CMS to improve the quality of data submitted to CMS. Thanks to EDPS, CMS can now recognize developments and implement changes to advance its MA program on a much greater scale. 

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