What we do

Encounter Data Validation & Analysis

We provide Medicaid encounter data validation and analysis services to help state Medicaid agencies improve managed care oversight, strengthen data quality, and ensure compliance with Centers for Medicare & Medicaid Services reporting requirements. Our team combines encounter data reconciliation, MMIS validation, source documentation review, operational assessments, advanced analytics, and external quality review support to help agencies maintain complete, accurate, and reliable encounter data for rate setting, program integrity, financial reporting, and performance monitoring.

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Ensuring Complete, Accurate, & Reliable Managed Care Data

Accurate encounter data is essential to effective oversight of Medicaid managed care programs. States rely on encounter data to support rate setting, monitor utilization, evaluate program performance, and meet federal reporting requirements.

We support state Medicaid agencies in validating and analyzing encounter data submitted by managed care organizations (MCOs). Our work helps ensure that encounter data is complete, accurate, timely, and aligned with financial and operational realities.

How We Validate Medicaid Encounter Data

Our encounter data validation services combine data reconciliation, source documentation review, operational assessments, advanced analytics, and performance reporting to help state Medicaid agencies ensure encounter data is accurate, complete, and compliant with Centers for Medicare & Medicaid Services (CMS) requirements. By validating encounter data throughout the reporting lifecycle, we help agencies strengthen managed care oversight, improve data quality, support external quality review (EQR) activities, and increase confidence in the data used for rate setting, program integrity, and federal reporting.

We perform detailed reconciliation of encounter data to assess completeness and accuracy across systems.

Our services include:

  • Reconciliation of encounter data to Medicaid management information system (MMIS) data and health plan source systems.
  • Validation of encounter submissions for completeness, accuracy, and timeliness.
  • Identification of discrepancies between encounter data and financial reporting.
  • Testing of encounter data across health plans and delegated vendors.

We use advanced analytics to identify trends, anomalies, and potential risks within encounter data.

Our work includes:

  • Analysis of utilization patterns and service trends.
  • Identification of data gaps, inconsistencies, and outliers.
  • Comparison of health plan performance across programs and peers.
  • Evaluation of encounter data in relation to contractual and regulatory requirements.

Encounter data quality is closely tied to health plan systems and processes.

We support agencies through:

  • Review of health plan encounter data submission processes.
  • Evaluation of internal controls and data aggregation methodologies.
  • On-site or virtual assessments of health plan operations.
  • Identification of process gaps and areas for improvement.

Where appropriate, we validate encounter data against underlying documentation.

Our services include:

  • Comparison of encounter records to claims data and medical records.
  • Validation of data elements against source documentation.
  • Assessment of alignment between clinical services and reported encounters.

We provide clear, actionable reporting to support ongoing oversight and improvement.

Our work includes:

  • Development of reports and dashboards to monitor data quality and compliance.
  • Evaluation of health plan performance against submission requirements.
  • Support for development and monitoring of corrective action plans.
  • Ongoing tracking of issue resolution and data improvement.

We support encounter data-related components of external quality review (EQR) activities, including:

  • Validation of encounter data in accordance with EQR protocols.
  • Integration of encounter data analysis into broader oversight activities.
  • Support for reporting and documentation requirements.

Informed by Broader Managed Care Oversight

Our encounter data validation work is part of a broader managed care oversight approach, including financial data audits, compliance reviews, and performance monitoring.

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Connect With Our Team

Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.

Kathy Haley, CFE, CCA, MP, COC, CHC, CPC
Principal

Email: khaley@mslc.com
Phone Number: 317-815-2937

Janae Jensen, CPA
Member

Email: jjensen@mslc.com
Phone Number: 816-957-6280

In the Words of our Clients…

Myers & Stauffer’s staff are professional, knowledgeable, responsible, accountable, and ensure they are meeting the needs of their clients. 

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