Software

Edge Complete™

An end-to-end data lifecycle claim management solution for payers that want to streamline workflows, simplify status reporting, and facilitate timely delivery to meet ACA Edge Server requirements.

 

Get Support
Contact Sales

OptimizeEdge Server Data

  • Enhance data visibility with Collection Process Tracking and Outbound File Monitoring. Dashboard views validate data sources, show status, and display files sent to the required counter-party for visibility into submission resolution.

  • Facilitate error-resolution activities with intuitive error management tools aligned with operational workflows. Risk adjustment and reinsurance insights support error prioritization and client-driven error assignment.

  • Seamlessly receive, process, translate, and analyze return response files. For edge servers, Edge Complete provides translation and viewing for all CMS xml reports including risk adjustment and IVA reporting.
  • Reduce data drop-off and minimize orphaned claims with enrollment pre-validation processing. This function looks for potential enrollment data problems such as duplicate members, new or dropped IDs, and unexpected masked IDs.

  • Leverage professional management of edge servers. Minimize challenges and resources to take advantage of the expanded reporting set including the baseline dashboard, orphaned claims management, and pre-enrollment validation.

  • Identify and manage orphaned claims to help mitigate risk to revenue.  Analytics reporting for interim billing supports collaborative final bill creation.

Edge Server Data Transformation and Submission

  • Inbound file process summary

    • Allow risk managers to monitor and access claim data for use with improvement opportunity plans with member enrollment and supplemental Inbound File Process Summary screens.
    • Review statistics across the submission life-cycle including valuable insights in to claims, member enrollment, and supplemental acceptance and rejection rates.
    • Confirm that monthly file sets were received, successfully processed, and error rates are within expectations.

  • Baseline dashboard

    • Gain direct insight into the edge server responses at summary and commercial insurer levels.
    • Leverage quantity evaluation metrics for enrollment and claim count baselines, acceptance and rejections, orphaned claims, and re-insurance information.
    • Track and manage progress toward the critical CMS baseline.

  • Error management

    • Assign and track errors to staff members for error resolution with a workflow friendly tool.
    • Prioritize errors for maximum risk adjustment impact.
    • Filter risk adjustment eligibility based on CMS published rules and the procedure and bill type codes with Data Claim Look-Up.

  • Reporting and analysis

    • Present members with reinsurance opportunity through the “Reinsurance” feature in the “Analysis” module, which includes analysis results such as the largest contributing factor to maximize the opportunities.
    • Access a listing and drill down information for all the translated XML files that are run from the edge server with the “CMS Edge Reports” module.
    • Cross-reference member IDs to masked member IDs with multiple search options with the Edge Complete “Reference – Masked Members”.

Our outcomes

View all insights

Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Learn how an AI-driven review of a health plan’s Medicare Advantage claims produced an annualized gain of $357,000

Learn More

Video

Optimizing Risk Analytics with a Data Integration Cloud

Video

Optimizing Risk Analytics with a Data Integration Cloud

Learn how our Integrated Delivery Platform aggregates data from disparate systems to: Optimize risk analytics, Ease compliance with CMS mandates, and more.

Learn More

On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

Watch this AHIP webinar to discover best practices for integrating risk, quality, and value-based care to improve outcomes and manage costs for Medicaid enrollees.

Learn More

Infographic

Managing reimbursement from start to finish

Infographic

Managing reimbursement from start to finish

Explore our end-to-end reimbursement management solutions.

Learn more

Podcast

Partnering for Change: The Benefits of Value-Based Care Models

Podcast

Partnering for Change: The Benefits of Value-Based Care Models

Guest: Serrah Linares

Episode: 2105 | Published: 03/15/2023

VP and Head of Solutions at Nuna, Parag Patel, chats about how the Prometheus Episode Grouper from Change Healthcare has helped Nuna better serve all.

Learn more

Fact Sheet

Healthcare Communications for Providers

Fact Sheet

Healthcare Communications for Providers

Leverage our deep experience in healthcare communications for providers and support cash flow, increase speed to payment, and contain costs.

Learn more

PRODUCT SUPPORT

Need support for
this solution?

Get support
Explore related solutions

Join Community discussions

Find and share knowledge, exchange ideas, and collaborate with peers and Change Healthcare experts to drive your solutions to success.

Let’s start a conversation

We’re here to help you find out how this solution could benefit your organisation. Complete the quick form to the right, and someone will reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

Want more information? Start here.

Thank You

We appreciate your interest in Change Healthcare. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.