SCIOSubmissionMaxTM - how does it work?
Rejected clinical data that is not corrected and resubmitted results in loss of revenue for health plans. SCIOSubmissionMax is a simple, hosted software that identifies and corrects RAPS errors in CMS rejected diagnoses.
SCIOSubmissionMax is designed to simplify the analysis, correction and resubmission of CMS RAPS rejects even after the claim has been paid. Clinical information from Medicare Advantage claims and encounters are forwarded to and used by CMS to determine monthly risk based capitation payments. With a single click code identification and correction process, this software is easy to implement. Data analytics helps identify and manage the correction and resubmission of rejected diagnoses as reflected in CMS RAPS return files. After the files are adjusted, a revised RAPS file is created for the health plan to export and submit to CMS.
Investing in a correction software improves CMS revenue and also risk scores for health plans.
- Easy to implement as it uses CMS files already sent for SCIORevMaxPro™
- Root-cause analysis identifies trends in error codes and shares information to minimize recurrence and fix process breakdowns
- Corrects RAPS errors even after the claim has been paid
- Working with CMS rejected diagnoses is a best practice for risk adjustment
- Simplifies corrections and eliminates the need to reprocess a claim
- Improves the bottom line by tackling under reporting of chronic conditions and rejected clinical data