Acceptance or Rejection of EDGE server data might be cause for celebration or rethinking a data integrity strategy.
After several deadline extensions, insurers must submit their EDGE server data for reinsurance and risk adjustment programs, by May 15, according to a recent update from Centers for Medicare and Medicaid Services (CMS). It is imperative insurers meet this deadline, as CMS will not accept any data after 4 p.m. EDT.
The Department of Health and Human Services (HHS) will use the enrollment, medical claims, pharmacy claims, and supplemental diagnosis code data insurers upload to calculate risk scores for its Risk Adjustment and Reinsurance programs.
This requirement proved rather stressful for many insurance companies, as HHS accepts or rejects data according to certain criteria. Insurers will have to investigate, correct and reprocess any rejected data – a laborious process that could prove costly in both time and resources. HHS has tasked insurers with the burden of managing an EDGE server under very strict technical specifications. And insurers must ensure data measures up, as it plays a critical role in their financial performance calculations.
Given the importance of data integrity for the review, insurance companies with a solid data management and enterprise controls strategy should fare well under HHS’ assessment. The best solutions provide end-to-end management of the data preparation, as well as a submission and error resolution process. This model fortifies data integrity and guards against errors.
The journey to finalize a deadline has been long and winding, to say the least. As detailed by an Infogix blog post in June of last year, CMS previously extended the submission deadline several times. After multiple communications that the final submission deadline would not extended past April 30, 2015, ultimately, HHS eventually granted insurance companies an additional 15-day grace period from the April 30, 2015 deadline This allows more time for final data submissions, reconciliations, and error resolution to ensure the most accurate data is being reported.
Time will tell if insurers were well prepared and those that did not fare well, might need to revisit their data integrity strategy to ensure this never happens again.