Risk Submissions Frequently Asked Questions

Is the solution hosted, or is there software to be installed on the desktop?
The Centauri Relay data submission solution is 100% hosted. There is no software to install, which often involves updates that are burdensome and difficult for clients to maintain.

What lines of business do you support?
Currently, Centauri Relay supports EDPS and RAPS data submissions for Medicare Advantage only.

How often are files submitted to CMS?
EDPS files are submitted according to CMS' published schedule, which is at least once per month but more frequently depending upon plan size. RAPS and other files are submitted on a mutually agreed upon schedule. Files are transmitted between Centauri and the health plan via secure FTP transfer. In most cases, custom submission schedules can be accommodated as long as they are compliant with what CMS requires for the plan size.

Does Centauri Relay support the parallel submission of EDPS and RAPS?
Yes, and it will continue to do so until RAPS is officially retired by CMS. It is recommended that RAPS submissions be created from EDPS submissions, since RAPS is a subset of the EDPS data.

How long has Centauri been submitting EDPS and RAPS on behalf of clients?
Centauri has offered its hosted Centauri Relay platform for end-to-end data management capability for Medicare Advantage encounter data and RAPS data since November 2015. The team that supports Centauri Relay has over 100 years of combined experience developing, supporting and implementing risk adjustment submission solutions for commercial and government programs.

Does Centauri Relay accept formats other than an X12 837?
Yes, as long as it contains the minimum data set required by CMS. Upon implementation, a gap analysis is performed between the proposed format and the X12 837 CMS published requirements to ensure that the format completely and accurately sources and captures all required data elements.

Can Centauri Relay extract data directly from an EMR/EHR system to populate the EDPS/RAPS submissions?
Not at this time because of industry compliance concerns with accessing external systems as well as the complexity involved in maintaining APIs for every possible EMR/EHR platform.

What reporting is included with Centauri Relay?
Robust and interactive dashboard-style reporting is provided with Centauri Relay. Because clients have different risk adjustment business intelligence needs, filters and drilldown with export capability facilitate self-serve reporting through our Submissions Dashboard as opposed to providing a standard set of reports that may or may not work for clients without paying for custom development. The Submission Dashboard provides reporting that facilitates the ability to efficiently reconcile and track the submissions lifecycle and audit trail for each individual record, including those that are held by Centauri Relay for errors that would cause rejection at CMS, adjustments and supplemental data both linked and unlinked. EDPS and RAPS comparative analytics are also available through the Centauri Insights portal, and specialized financial reporting can be developed.

How does Centauri Relay handle EDPS supplemental data that results from chart review and in-home assessments?
Whether a health plan client is using the Centauri Advance medical coding platform, providing an extraction file from its own coding systems, or relying on their external chart review vendors to submit files for EDPS, Centauri Relay is able to create complete and accurate linked and unlinked submissions in the manner and cadence required by CMS. Each health plan's needs for handling supplemental data are unique, are specifically addressed in implementation planning, and can be adjusted as necessary. The Centauri Relay Submissions Dashboard contains reporting and intelligence specific to supplemental data submissions for clear and efficient visibility into their status.

What kind of diagnosis filtering logic is applied by Centauri Relay?
For EDPS submissions, CMS has mandated there to be no filtering. For RAPS, filtering is applied according to the current risk model specifications and CMS guidance, and can be customized according to a client's particular needs.

Can rejections be prioritized by risk score impact?

Does Centauri Relay offer online error correction?
No. Due to audit and compliance concerns the industry best practice is to correct data quality issues in the health plan source systems. Depending upon the type of error, Centauri can perform enrichments/transformations to proactively address data quality issues prior to submission as long as the meaning of the data is unchanged, such as ZIP+4 default, using CMS NPPES data to assist in mitigating NPI-related issues, removing duplicate diagnosis codes and providers, and other format and syntax issues.

Do you provide ongoing technical and/or other support?
Each client is assigned their own Client Services Representative, who can assist them with their technical and support needs.

We handle our own EDPS and RAPS submissions; why would we need a vendor?
There are many reasons a health plan would choose to utilize a vendor. One of the most common reasons is that their claims system has technical limitations that render it incapable of producing a fully compliant 837 outbound encounter that can pass all CMS validations and/or the reconciliation of the various CMS responses to the submissions. Additionally, as a strategic and expert advisor, Centauri can provide critical insight which can helps their clients to gauge impacts of changes in CMS regulations and guidance pertinent to risk adjustment and its required submissions

Does Centauri offer consultative services for those health plans that may not require a full end-to-end solution, but are interested in holistic evaluations of risk adjustments against industry best practices?
Yes, we offer consulting services. Please contact us at info@centaurihs.com for pricing.