CMS EDGE Server Solution
Background :

Under the ACA,EDGE Server was introduced to manage the risk and underwriting. CMS created an EDGE Server to be hosted as self-hosted or on Amazon cloud. All Qualified Health Plans are required to submit de-identified plan data to CMS on a fixed schedule.

Problem :

Many health plans faced the challenges of keeping up with CMS timeline and data reporting complexities. This process required a full-time Project Manager, Systems Analyst and Developer.

Solution :

Eixsys has developed a solution that requires less resources to manage end-to-end process and meet all deadlines of CMS baseline and detail reporting requirements. We are the subject matter experts who follow the EDGE Server business rules and guidelines, while working closely with medical underwriters and actuaries to deliver Risk Adjustment and Reinsurance Program reporting.

Result :

Meets all CMS required timelines, avoiding penalties, such as the risk adjustment default charge for insufficient data reporting.