Risk Adjustment

Comprehensive Submissions

Clearinghouse + EDI

Streamline and improve submissions and vendor management.

Scalable, flexible, integrated solution to help ensure timely, complete, and compliant encounters for all government-sponsored programs, including Medicare Advantage, Managed Medicaid, (S)CHIP, ACA/EDGE and All Payer Claims Database (APCD).

  • Provides 360-degree view of data during the entire submission lifecycle for easy source data reconciliation
  • Validates 100% of your submission data prior to submission to help you get paid the right amount the first time
  • Assigns HCC and determines risk-eligibility so users can review and prioritize error correction and submissions based on projected risk revenue and impact
  • Provides integrated on-line error correction capability with configurable workflows so users can easily fix errors to facilitate faster and proper reimbursement without engaging claims staff

Take Control of Your Data for Better Results

The volume of data required for government programs today can be overwhelming. Veradigm Comprehensive Submissions (formerly Reconcili8 and Babel Health), eases those burdens with end-to-end submission and reconciliation processes that ensure regulatory compliance and mitigate revenue leakage.

Our solution puts control of the encounter submission process squarely in the hands of your risk adjustment team, creating full transparency. Manage work, error correction, and production control to gain insight into critical financial and administrative intelligence. And it’s all done through one multi-program interface with user-friendly dashboards, and complete, real-time data access.

Create self-reliance for your risk adjustment team with submission and error correction on your schedule — not your vendor’s. Increase acceptance rates while reducing legwork. A simpler, more streamlined encounter submissions experience is waiting for you.

  • Get a 360-degree view of data during the entire submission lifecycle for easy source data reconciliation
  • Easily fix and prioritize errors based on projected risk revenue and impact without engaging the claims processing staff or vendor
  • Configure workflows for batch correction, reviews and approvals, and re-submissions
  • Experience intuitive operational dashboards

Understand Financial Implications of All Encounter Data

Veradigm Comprehensive Submissions enables complete and accurate tracking and status-monitoring of all encounters. You can manage the entire encounter lifecycle with impactful data visibility from claims intake, validation process, error correction, encounter generation, and response file processing.

Our platform assigns risk-eligibility and Hierarchical Condition Category (HCC) along with identifying encounters’ potential risk revenue during the data upload process. This early function can help drive business decisions throughout the data correction, file preparation, and file submission operational processes.

  • Identify areas of potential revenue opportunity to maximize revenue
  • Provide insight into the risk impact and revenue potential of encounters, including those that have been accepted, rejected, or failed validation; along with encounters deemed unreportable or unrepairable
  • Integrate with our Risk Adjustment and Analytics product for visibility needed to monitor and manage risk adjustment revenue against budgeted gap closures and KPIs

Minimize Risk and Maximize Revenue

Veradigm Comprehensive Submissions is a fully managed, cloud-based encounter data management platform that offers a CMS-approved, HIPAA-compliant environment. Your tech team no longer has to maintain numerous products, interfaces and releases while coordinating with multiple vendors. Instead, you can refocus your in-house IT talent on other strategic projects.

Our Submissions Solution speeds and simplifies the encounter submission process while helping health plans ensure complete, accurate and compliant encounters. Our powerful extract, transform, and load (ETL) tool pre-validates 100% of your submission data, resulting in accurate and complete submission that gets health plans paid the right amount on time. Additionally, our platform imports any file format and lets you easily map and transform data to meet regulatory guidelines.

By pre-validating 100% of your encounter data to alert you to errors prior to sending, our innovative ETL tool empowers you to ensure more complete, accurate and compliant submissions the first time around. As a result, you’ll collect the accurate reimbursement you’re owed — sooner — from government-sponsored programs.

We show you exactly where the errors are — and give you the opportunity to correct them before sending. You can minimize rejections and ensure accurate and timely reimbursement with cleaner data.

  • Validates all data pre-submission based on CMS and state requirements so you can assure your submissions are complete, accurate and compliant
  • Easily fix errors before and after submission to facilitate proper reimbursement
  • Compatible with all chart vendors, so it’s easy to adopt
  • Works with all input file types based on an intelligent, self-learning data loading process
  • Full auditing and versioning features across all data elements
  • CMS-approved and HIPAA compliant submissions

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