Schedule a Demo Search

Identify and Resolve Encounter Data Quality Issues

The complex nature of the encounter data process creates many issues for healthcare organizations, including an average 1%-3% of premium lost due to unreported risk. Gone unresolved, data quality issues can have a negative impact on performance.

Pareto’s Data Integrity solution independently analyzes data generated by providers, payers and CMS by applying detailed encounter-level analytics to uncover data quality issues suppressing risk scores, impacting quality measures (HEDIS®/Stars) and/or posing potential compliance issues.

20:1 ROI

average for clients in the MA and ACA markets

$30 TO $50

average PMPY impact for underreported risk in the MA and ACA markets

60% TO 85%

of data quality issues exist prior to submission, requiring an end-to-end evaluation of encounter data processes

100%

of Pareto’s Data Integrity evaluations lead to improved financial accuracy

Automate & Prioritize Gap Identification & Remediation

Our solution offers a comprehensive analysis of end-to-end encounter data accuracy to automate and prioritize gaps for remediation. We utilize proprietary algorithms to uncover the primary root causes impacting revenue and compliance, allowing you to resolve issues at the source and prevent future inaccuracies.

All results of our analysis are delivered on our secure, web-based tool with configured reporting to enable speedy resolution and resubmission to CMS in advance of submission deadlines.

 

Holistic Data Evaluation

  • Encounter-level data evaluation identifies where data quality issues exist
  • Financial exposure quantification determines the value of data discrepancies and prioritizes remediation
  • Root cause investigation allows for resolution of issues at the source
  • Web-based platform provides actionable insights into current performance and allows for additional data exploration
  • Compliance evaluation identifies potential under- and over-reported encounter submissions
Ensuring complete and accurate encounter data requires a comprehensive understanding of the data process and transformation from encounter through to regulatory submission.

Complexities of the Encounter Data Process

  • Data intake from disparate sources: Providers, Clearninghouses, Ancillary Claims, Supplemental Claims
  • Processing & Submission: Front End System Edits, Claims Processing System, Electronic Data Warehouse, Regulatory Data Submission Preparation
  • Regulatory Processing: State Encounter Reports (Medicaid), RAPS Response (MA), EDS Response (MA), EDGE Response Reports (ACA), HEDIS/Stars Submissions

Why Pareto?

icon

Compliant

We focus on complete and accurate encounter data to mitigate compliance exposure.

icon

Data on Demand

Pareto Hub offers unparalleled access to insights through a ready-to-analyze data environment, enabling users to build independent analytics in a self-service manner.

icon

Flexible

From a one-time diagnostic assessment to full operational evaluation, we offer multiple delivery options, as well as configurable outputs to support specific needs.

Read a Success Story

Data Integrity: ACA

Pareto’s Data Integrity solution identified the root cause of gaps in reported risk to focus remediation, resulting in $7.7 million in financial improvement opportunity for a 115,000-member ACA plan.

Read

A Powerful Foundation

     
icon

Our Data Management Platform

Pareto’s Data Management Platform, the foundation to our solutions, is built around data lake, artificial intelligence, and open source big data technologies to allow us to effectively ingest data in all formats and types at scale, organize them with appropriate data governance mechanisms within our data catalog, and provide efficient configuration capabilities to democratize data access and analytics.

LEARN MORE

See it and Believe it

Our demos say it all. Tell us about your challenges and we’ll show you how we can help you overcome them.

Schedule a Demo