Get to Know the Encounter Data Resource Hub
Improving encounter data reporting is critical to advancing healthcare equity and affordability in California. As the Encounter Data Governance Entity (EDGE), funded through a grant from Health Net, LLC, the Integrated Healthcare Association (IHA) is coordinating initiatives to improve how encounter data is collected, reported, and used.
Central to the effort is IHA’s Encounter Data Resource Hub, a publicly accessible platform to optimize encounter data reporting across California’s healthcare community where community health centers (CHCs), health plans, and other stakeholders can easily access promising practices, helpful tools, and easy-to-use guidance. Since its launch in July 2022, the Resource Hub has received over 15,000 website visits and over 1,200 tool downloads.
Why This Matters
Encounter data complexity is hard to navigate, especially for new staff at a California CHC. Having a better understanding of how all the health center roles function together to produce claims and encounter data will help support the connection between quality encounter data and better patient care, improved health outcomes, and stronger health center revenue.
The Encounter Data Resource Hub is here to help your staff better optimize encounter data workflows and collaborate across teams. Altogether, there are 28 resources on the Hub – all are ungated, meaning health center staff do not need to login or provide an email to download the tools.
Recommended Resources for CPCA Members:
Revenue Cycle Management Bootcamp
This series offers “out of the box” presentations for educating staff on Revenue Cycle Management and how encounter data not only drives health center revenue, but also the quality of patient care through population health management. California Medical Association Physician Services Organization (CMA PSO) developed this resource in partnership with CHC subject matter experts throughout California. The Bootcamp is divided across processes and roles and covers information for the following teams: C-Suite, Revenue Cycle/Billing, Front and Back Office, Providers, Health IT, and Quality Improvement.
Best Practice: Submitting Newborn Encounters
This presentation is intended to provide clear and consistent guidance for how to submit newborn encounters. Designed as a training resource for healthcare organizations, it covers the various scenarios that may arise in submitting newborn encounters, including submission guidelines for Medi-Cal and other lines of business, 837 sample submissions and instructions on how to report newborns with and without a client index number (CIN), how to report multiple births, and how to properly use of diagnosis codes and modifiers.
Understanding Patient Registration and Insurance Eligibility
Did you know that almost half of claims denials are caused by errors during the patient registration and insurance verification process? This training covers the different types of health care coverage in California and explains how proactively verifying patient insurance eligibility supports high-quality encounter data generation at health centers.
Health Plan Quick Reference Guide (Medi-Cal)
Developed by CMA PSO, this guide outlines available encounter data submission resources, requirements, and contacts from the major Medi-Cal health plans. Use it to save time and effort from searching for encounter data submission resources. The reference guide is editable so community health centers can update and expand it as needed.
Recently, attendees at CPCA’s Quality + Technology Conference got to hear from EDGE Program Manager, Erika Vijh, MHA, on how encounter data improvement is unlocking progress for health centers and Managed Care Plans. If you’d like to get in touch with IHA’s Encounter Data Improvement team, please email encounterdata@iha.org.