Healthcare risk adjustment

EDGE ASSIST

Milliman EDGE ASSIST

The Concern

Your Solution

Benefits

Insight

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The concern

ACA data submissions are complex, frustrating, and prone to errors.

Effective ACA EDGE server management requires following and understanding mountains of CMS rules, specifications, and guidance—all while hitting deadlines over months of effort. Submitting incomplete or erroneous information can cost millions in revenue.

Your Solution

Full-service ACA EDGE submissions backed by a transparent, proven approach

The EDGE ASSIST process, backed by Milliman’s deep risk-adjustment expertise, maximizes ACA risk transfers while ensuring compliance with CMS regulations. Our transparent solution covers the entire ACA EDGE cycle, including data ingestion and validation, submission, error identification, and assistance with supplemental diagnoses. We support these technical activities and analytics with our vast knowledge of the ACA risk-adjustment program to ensure accurate data and appropriate member risk scores.

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Expertise

Milliman has the expertise to maintain your EDGE server, including contracting, configuring, acquiring CMS provisioning software, and registering. Upon successful completion of data processing and reconciliation, we will complete the submission process by properly transforming the data and loading it into the EDGE production environment.

Continuous process

We have a continuous process for reviewing and reconciling EDGE submissions and will work with you to ensure each submission passes our daily quality standards. We will also help you track your data over time and identify patterns, before your data reaches EDGE, to uncover signals of systemic weaknesses in your overall data management process.

Clarity

Additionally, Milliman brings clarity to error reports through precise summaries of these errors paired with direct action items as part of a larger strategic plan for correcting errors and improving data quality. We can identify the errors offering the most potential risk score value to help your team effectively deploy and allocate resources.

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INSIGHT

Related insight

Article

Making EDGE work for you

Improper process management, a few inaccuracies, or inadequate data security can have a considerable financial impact on your Affordable Care Act (ACA) business.

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Article

In it for the long haul: Best practices for navigating annual EDGE server submissions

We share best practices to maximize submissions for External Data Gathering Environment, a requirement under the Affordable Care Act.

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Article

Taking the EDGE off: Minimize stress while maximizing ACA risk adjustment through EDGE server best practices

This paper outlines action steps health plans should consider as part of their annual EDGE server submission cycle.

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Article

ACA risk adjustment management: Cracking the code

This paper addresses strategies to facilitate an organizational coding completeness initiative and “crack the code” on the tools and methods for increasing risk adjustment management’s success.

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White paper

ACA risk adjustment management: Higher EDGE-ucation

An article to introduce the broader concept of risk adjustment management.

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Article

ACA risk adjustment management: Going all-out

This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.

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Article

ACA risk adjustment management: Time to keep score

This paper explores some of the more useful types of analytics a commercial health plan can leverage to monitor the performance of its Patient Protection and Affordable Care Act block and keep a better risk score.

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