• RAPS (Risk Adjustment Processing System) report of internal and external encounters is submitted to Medicare. eClusive’s TruChart technology scrubs data for published CMS edits to reduce failures. Report is reviewed with health plan prior to submission.
• EDS (Encounter Data Submission) report of external encounters is submitted to CMS on a monthly basis. Our TruChart technology provides response files for TA1, 999, 277CA and MAO-002 acknowledgements and status reports.
• Claims reporting by specialty, provider, claim, participant, and more is available through eClusive’s TruChart Analytics technology. Automated scheduled email delivery of selected reports routes data to key decision makers.
• General Ledger and Check Summary allows PACE to view claims in their customized chart of accounts format. A Check Summary of paid claims is provided monthly.
• Claims lag reporting will display the average lag between the service fulfillment and claim payment. Health plans can use this for Incurred but not Reported (IBNR) calculation, cash reserve needs, and regulatory reporting.