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CMS Compliant Encounter Processing & Risk Adjustment

Data Driven, Scalable & Intelligent SaaS Platform

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  • HIPAA Compliance Checker
  • Interactive web portal and Dashboard
  • Maximize Reimbursements
  • Realtime Encounter Data Reporting
  • Chart Review Generation and Submissions to CMS

Wipro's Encounter Data Processing System (EDPS) helps maximize reimbursement, reduce administrative costs, improve accuracy, 100% compliant with CMS and gain valuable insight into Encounter data.

EDPS is a HIPAA compliant processing solution that receives, transforms, and transmits complete, accurate, consistent and compliant Encounters within defined time limits. The response transactions are automatically applied and made available in Wipro's modular SaaS web platform.

EDPS integrates and processes the encounter files in various formats, performs seven levels of compliance checks through integration with Wipro's analytical platform. It provides in-depth reporting and tracking, and analysis capabilities on financial, and other critical measures.

Medicare Advantage organizations can leverage Wipro's EDPS system to improved insight, decision-making capability and strengthen financial performance.

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Powerful, Intuitive and Reliable EDPS Solution


Lives Supported


Active Customers


Encounter Submissions per annum


A Comprehensive Encounter Data Processing System

Flexible Inbound File Format

837 5010 X12 and proprietary data sources converted to HIPAA compliant CMS Outbound 837 X12 files

HIPAA Compliance Checker

Provides HIPAA compliance, additional compliance edits, error analysis, corrections, and re-submission of the rejected encounters to CMS

Interactive Dashboard

Comprehensive dashboard featuring real-time submission performance, encounter counts and current status

Hosted Environment

Data storage for all inbound and outbound encounter data files and CMS response files

Chart Review Data Processing & Reconciliation

Processing of linked and un-linked supplemental encounters for submission to CMS

Audit Preparedness

In-depth reporting, tracking and analytic capabilities for reconciliation process and mitigation of risk exposure

CMS Partnership since 1986

99.9% CMS Compliant Solution

Maximize Reimbursement

100% compliant Encounter data submission to CMS for services provided to Medicare beneficiaries

Improve Accuracy

Reduce number of rejected encounter by leveraging Wipro compliance checker, a pre submission verification engine

Increase Efficiency

Automate encounter submission with flexible inbound file formats and transcribe into CMS compliant format (837 v5010)

Valuable Data Insight

Identify HCC opportunities based on CMS models, chart data and comparing compliance edits with various files

Reduce Cost

Integrated solution with Medicare Advantage/ Medicare Medicaid Plans within one UI. Ensures more efficiency and flexibility

Minimize Risk

Minimize RAPS errors by preparing, processing, reviewing and reconciling data from Risk Adjustment Processing System


Managing and transforming one of the largest BCBS Organization in the USA

Risk stratification and predictive model using CMS HCC model

In order for CMS to accurately compute risk score and payments, Health Plans are required to submit multiple data sources including Member information, RAPS, and Encounters.

Significant changes to the HCC Risk Adjustment model, Diagnosis Code Models, and Submission methods were made. The Wipro solution helps maximize CMS payments for Health plans

HCC360 Identifies HCC to Maximise Revenue and Compliance


Accurate and timely reconciliation of medicare enrollment and payments

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Integrated Health Risk Assessment Solution

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