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EDPS Diagnosis Filtering API

Automate Risk Adjustment Code Filtering with Confidence

Are you tired of navigating complex CMS EDPS filtering logic manually?
Say goodbye to spreadsheets and inconsistent results. Our EDPS Diagnosis Filtering API delivers CMS-compliant diagnosis filtering, empowering Medicare Advantage Organizations (MAOs) to streamline risk adjustment workflows and maximize coding accuracy.

💼 Business Features & Benefits
  • CMS-Compliant Filtering
    Automatically applies Medicare EDPS rules to filter diagnosis codes by CPT/HCPCS, TOB, location, and provider type.
  • Audit-Ready Logic Trail
    Every filtered diagnosis includes metadata explaining why it was included or excluded—perfect for internal reviews and CMS audits.
  • Boost Coding Efficiency
    Enable human coders and automated systems to work faster with consistent, reliable filtering outcomes.
⚙️ Technical Implementation
  • FHIR-Based Input: Accepts standard FHIR R4 JSON Bundles including Encounter, Condition, and Procedure resources.
  • Real-Time Filtering: Processes records in under 500ms with batch support for up to 1,000 records per call.
  • Clear Output: Returns filtered diagnosis codes and exclusion reasons, fully traceable per encounter.
  • Versioned API Endpoint: /v1/filterDiagnosis
🎯 Try the Demo Now

Experience firsthand how easy it is to eliminate risk and boost your coding workflow.

API Test Interface

Upload a FHIR Bundle (JSON) or paste it directly in the editor below:

Encounter ID Type Diagnoses Procedures
# Encounter ID Type Eligible Diagnoses Ineligible Diagnoses Exclusion Reason
Filtering Rules

  • Accept if any associated Procedure has an acceptable CPT/HCPCS code
  • If accepted, include all Condition codes linked to the encounter
  • Excluded if all codes are from the CMS Excluded Services list
  • Excluded if encounter is voided

  • Accept if TOB code starts with 11X or 41X
  • Use all linked Condition resources
  • No CPT/HCPCS filter is applied
  • Excluded if TOB code is 118 (voided inpatient)

  • Accept if TOB code is in valid outpatient TOB list (12X, 13X, 14X, 22X, 23X, 71X, 73X, 77X, 85X)
  • At least one associated Procedure must have an acceptable CPT/HCPCS code
  • If accepted, use all linked Condition resources
  • Excluded if TOB code is 128 (voided outpatient)
  • Excluded if all codes are from the Excluded Services list
API Documentation
Endpoint: /v1/filterDiagnosis

This API filters Medicare Advantage diagnosis codes for risk adjustment eligibility according to CMS EDPS rules.

Request
  • Method: POST
  • Content-Type: application/json
  • Body: FHIR Bundle containing Encounter, Condition, and Procedure resources
  • Query Parameter: paymentYear (optional, defaults to 2025)
Response
  • Content-Type: application/json
  • Body: JSON object containing filtered diagnoses and exclusion reasons