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Ments that are required to be populated in order to pass Encounter Data System translator and CEM level edits are provided below. MAOs and other entities must include at least these minimum data elements when they submit encounter data. MAOs and other entities can use this information for the submission of paper claims, member reimbursement claims, claims from foreign providers, etc. The situational fields associated with these minimum data elements must also be submitted if the situation is pre.

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An encounter is the actual provision of services to the patient. Claims are requests for reimbursement from healthcare providers for providing a service to a patient.

The encounter data set also includes selected information about the service provided including the date or dates of service, the procedure code, which tells which service was provided, and the diagnosis or diagnoses, describing the condition that required the care.

Under the FFS model, the state pays providers directly for each covered service received by a Medicaid beneficiary. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan.

>> DEFINITION OF PATIENT ENCOUNTERS CMS defines patient encounters as any encounter where a medical treatment is provided and/or evaluation and management services are provided, except a hospital inpatient department (Place of Service 21) or a hospital emergency department (Place of Service 23).

In summary, encounter data are similar to fee-for-service (FFS) claims data, but encounter data are not tied to per-service payment from the payer to the managed care provider, because the payer is not reimbursing individual services.

A Comprehensive Encounter Data Processing System. Wipro's Encounter Data Processing System (EDPS) assists Health Plans in submitting Medicare Advantage, Managed Medicaid, and Dual Demonstration encounter data to the Centers for Medicare and Medicaid (CMS), and States.

* All-inclusive rates are billed by encounter, which means the calculation of a rate accounts for all of the allowable costs of providing care. This is the opposite of fee-for-service rates, where specific services are billed at specific rates, even if more than one service is provided during an encounter.

Encounter data is information that documents a person's diagnoses, treatments and services provided by a clinician or care facility for administrative purposes.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232