The Encounter Data Improvement Program

Health Net established the Encounter Data Improvement Program in 2016 pursuant to agreement with the California Department of Managed Health Care (DMHC) as part of DMHC’s approval of Centene’s acquisition of Health Net. The goal of this program is to mitigate barriers to the timely submission of complete and accurate encounter data, and strengthen the data collection and reporting infrastructure, particularly for Medi-Cal providers contracted with managed care plans. Objectives of this program include encouraging, testing and promoting new or enhanced models of encounter data submission; improving the skills, expertise and operational efficiency of providers and staff in collecting and reporting encounter data; and promoting technological improvements to increase encounter data collection and submission.

Solution Development

On behalf of Health Net, Manatt Health Strategies is leading an effort to engage stakeholders in the development of targeted and actionable strategies and tactics to improve encounter data reporting for Medi-Cal managed care providers.

In August 2019, nearly 100 encounter data reporting representatives from across California gathered in Sacramento for a “Kick-off” Summit to identify and prioritize California’s most pressing and intractable encounter data issues for resolution.  From September 2019 through February 2020 three stakeholder workgroups – focusing on Governance, Data Standardization, and Technology + Technical Assistance – developed resolution strategies to resolve critical encounter data reporting issues. Strategies were presented and workshopped by over 120 encounter data leaders at a virtual Summit in August 2020.

Encounter Data Governance Entity RFP

On September 1, 2020, Health Net’s Community and Infrastructure Investment Program released a Request for Proposals (RFP) seeking a non-profit “governance entity” (GE) to be responsible prioritizing, overseeing, coordinating, and monitoring encounter data improvement efforts in California, and seeking sources of longer-term, sustainable funding to support its activities.  The GE will be a non-profit corporation with a Board of Directors comprised of healthcare industry and regulatory leaders and encounter data subject matter experts, and will oversee Advisory Committees of subject matter experts to inform and guide its work.  The RFP is open to all interested and qualified non-profit respondents who have:

  • Encounter data subject knowledge
  • Medi-Cal Managed Care subject knowledge
  • Stakeholder management experience
  • Program implementation and system redesign experience

Letters of intent are requested by 5pm on September 9th. Responses are due by 5pm PDT on September 30, 2020. (See RFP Schedule of Events below.) Full and final workgroup recommendations are available on our Summit page.

RFP ReleaseSeptember 1
Deadline:  Intent to Bid (non-binding)September 9 at 5pm PDT
Deadline:  written questionsSeptember 9 at 5pm PDT
Question responses distributed or available upon requestSeptember 15
Deadline:  proposal submissionsSeptember 30 at 5pm PDT
Proposal evaluations completedLate October
Oral presentation and virtual site visit completedMid November
Notification of contract awardEarly December
Contract initiationMid December