SHMS Risk Adjustment Manager

Processes and tools to maximize risk-based reimbursement

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What is SHMS Risk Adjustment Manager

Risk submission (EDPS and RAPS) can be filled with potential compliance pitfalls, missed revenue, and operational quagmires. The SHMS Risk Adjustment Management system provides a comprehensive risk submission and tracking platform to ensure adherence to all government regulations, maximum risk-based reimbursement, and a clear operational process to ensure accurate and complete submission.

  • Completely automated submission to both RAPS and EDPS government systems
  • Department specific audit reports for issue resolution (claims, enrollment, provider operations, medical management, etc.)
  • Constantly updated to adhere to the latest CMS regulations
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AUTOMATION

Takes the complexity out of accurate and timely encounter submission

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ADHERENCE

The latest changes for both RAPS and EDPS are implemented to ensure adherence to regulations 

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AUDITING

Highly accurate and complete encounter submissions ensure that risk-based reimbursement is maximized 

More Information

From a technical perspective, the SHMS Payer Platform is a full-stack Microsoft .NET application and backend. Leveraging Microsoft SQL Server for data storage, analysis, and disaster recovery provides industry-best performance, reliability, and enterprise support.