Claims Processing Terms

1. Encounter Data Common Working File (EDCWF)

The EDCWF is a central database containing eligibility and claims history for all Medicare beneficiaries for encounter data purposes. For claims processing, the EDCWF verifies beneficiary enrollment and eligibility for the dates of service of the claim.

2. Encounter Data DME Processing and Pricing Sub-system (EDDPPS)

The Encounter Data DME Processing and Pricing Subsystem will process and price DME encounter data.  The EDDPPS is based on VMS processing.

3. Encounter Data Front-End System (EDFES)

The Encounter Data Front-End System includes the Electronic Data Interchange (EDI) Commercial Off-the-Shelf (COTS) Translator, the Institutional Common Edits and Enhancements Module (CEM), the Professional CEM, and the Durable Medical Equipment (DME) CEM.

4. Encounter Data Institutional Processing and Pricing Sub-System (EDIPPS)

The Encounter Data Institutional Processing and Pricing Subsystem will process and price Institutional encounter data. The EDIPPS is based on FISS processing.

5. Encounter Data Professional Processing and Pricing Sub-System (EDPPPS)

The Encounter Data Professional Processing and Pricing Subsystem will process and price Professional encounter data.  The EDPPPS is based on MCS processing.

6. Encounter Data Processing System (EDPS)

The Encounter Data Processing System is comprised of the Encounter Data Institutional Processing and Pricing Sub-System (EDIPPS), the Encounter Data Professional Processing and Pricing Sub-System (EDPPPS), and the Encounter Data DME Processing and Pricing Sub- System (EDDPPS).

7. Encounter Data System (EDS)

A data collection system used for the collection, processing, pricing, and storage of encounter data.

8. Encounter Operational Data Store (EODS)

The CMS repository for encounter data submissions. All encounter data is stored in the EODS.

9. Fiscal Intermediary Shared System (FISS)

The standard Medicare claims processing system used for all Institutional claims. The EDIPPS is based on FISS processing.

10. Multi-Carrier System (MCS)

The standard Medicare claims processing system for physician and supplemental services (i.e., lab) claims.  The EDPPPS is based on MCS processing.

11. ViPS Medicare System (VMS)

The standard Medicare claims processing system that processes Durable Medical Equipment (DME) claims from DME suppliers. The EDDPPS is based on VMS processing.