Encounter Plus

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    States have created All Payer Claims Databases (APCD) to produce transparency for consumers regarding price, resource use, and quality of care. They include data from public and private insurance companies operating within the state, and information on care for patients across care sites.

    Encounter Plus™ is a web-based application that allows health plans to manage the APCD and OSDS requirements. It supports submitting Institutional, Professional and Dental claims for various lines of business (Medicaid, CHP, HARP, Essential Plan, QHP, Off exchange Commercial, Medicare). It also supports management of vendor files.

    Key Features of Encounter Plus

    • Allows health plans to schedule claim imports from their core system and schedule the generation of submission files
    • Allows health plans to automate the assignment and tracking of errors
    • Enables configuration to automatically assign errors to appropriate resources
    • Permits automatic re-submission of claims that have been corrected or voided
    • Validation during claim import and file creation enhances submission accuracy
    • Configured to send claims to EIS and OSDS intake systems based on line of business

    Other Features

    • Built-in reporting capabilities provide visibility into the workload of each staff member and department as well as the state of the encounters
    • Custom views permit various user roles (e.g., administrator, manager, research staff and remediation owner)