SHMS Risk Adjustment Manager
Processes and tools to maximize risk-based reimbursement
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
AUTOMATION
Takes the complexity out of accurate and timely encounter submission
ADHERENCE
The latest changes for both RAPS and EDPS are implemented to ensure adherence to regulations
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.