Accurate Encounter Data a Must For Medicaid MCO Quality Measurement

With more than 60% of all Medicaid beneficiaries now enrolled in comprehensive, risk-based managed care organizations (MCOs), state Medicaid agencies that want to measure quality of those plans must have quality encounter data. Encounter data capture the items or services received by the member; they are managed care’s equivalent of claims in fee for service. CMS also depends on encounter data submitted by state Medicaid programs to maintain the massive Medicaid Statistical Information System (MSIS), a database of claims, encounter data, and beneficiary eligibility information.

– Managed Care Magazine

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