Encounter Data Improvement Program

Developing Sustainable Solutions for California’s Most Intractable Encounter Data Reporting Challenges

The accurate, complete, and timely submission of encounter data is critical to ensuring Medi-Cal program integrity, and is vital to help payers, providers, regulators and policymakers across all business lines better understand the populations they serve, monitor health outcomes, and respond to delivery system needs. However, encounter data also frequently faces severe data quality issues, particularly in highly delegated markets such as California.

Each time encounter data is transmitted between organizations – whether from a provider organization (PO) to an independent practice association (IPA), an IPA to a Managed Care Plan (MCP), an MCP to the state, or among the many Managed Service Organizations (MSOs) and clearinghouses in-between – it has the opportunity to be mis-reported and mis-interpreted. Multiple transmission points produce a “daisy chain” of incomplete and inaccurate submissions, and result in increasingly unreliable data.

This project, part of Health Net’s larger Encounter Data Improvement Program, will identify and develop actionable solutions to help resolve some of these most intractable encounter data reporting issues, aiming to improve encounter data quality across the California healthcare system.