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Documenting encounter data workflows

February 2024

A policy template to document and optimize encounter data submissions workflows at community health centers. This template covers workflows for submissions to all contracted health plans, for all items and services furnished to its members, whether directly or through clearinghouses, IPAs, or PPGs, including capitated providers. Community health centers can tailor this template to fit their organizational needs.

Author

California Medical Association Physician Services Org (CMA-PSO)

Why use it

Complete, accurate, reliable, and timely encounter and claims data is a vital component of providing quality healthcare. It is also a key component of the revenue cycle and the financial well-being of a health center. This policy and procedures template focuses on encounter and claims data submissions so health center staff can improve the quality of their data submissions.

Who it’s for

Health center leaders, including nurse supervisors, Chief Operations or Financial Officers, and Revenue Cycle Managers, can customize this policy template for their organizational needs to support process documentation and workflow optimization.

Key take-aways

Having a policy to support complete, accurate, reasonable, and timely submission of encounter data to all contracted payors can help engage all health center staff in improving the quality of encounter and claims data:

  • Health centers are increasingly participating in value-based payment activities and being able to produce higher quality encounter data through cleaner claims is becoming a critical area of focus.
  • Understanding how encounter data process improvement equates to better patient health care and more streamlined revenue are key concepts behind this policy template.

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IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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