Encounter Data Validation

To learn more, contact:
Jenny Klink
Vice President of Managed Health and Long-Term Care
1-800-362-2320 or 1-608-274-1940, ext. 8216

MetaStar conducts this optional external quality review activity that determines whether encounter data submitted by Managed Care Organization (MCOs)/Health Maintenance Organization (HMOs) is complete and accurate.

To evaluate the encounter data, MetaStar uses the methodology described in the Centers for Medicare & Medicaid Services guide, MetaStar conducts the review according to 42 CFR 438, Subpart E, using the CMS EQR Protocol 4: Validation of Encounter Data Reported by the MCO. MetaStar develops the methodology and tools for conducting and reporting results of quality compliance and comprehensive reviews, in collaboration with the Wisconsin Department of Health Services (DHS).