Encounter Data Submission Resources for PACE Organizations
This page provides information to support Program of All-Inclusive Care for the Elderly (PACE) organizations with the submission of risk adjustment data to the Encounter Data System. This resource is a centralized landing page consisting of information for relevant HPMS memos and announcements, technical guides, and other relevant resources.
HPMS Memos
PACE Organization Risk Adjustment Submissions to the Encounter Data System – January 29th, 2024
Provides technical instructions on the submission of risk adjustment data to the EDS for PACE center services for which a claim is not generated to aid with the transition to submitting all risk adjustment data to the EDS rather than RAPS for PACE organizations.
Final Encounter Data Filtering Logic – December 22nd, 2015 (PDF)
Provides information about how CMS filters risk adjustment eligible diagnoses from encounter data records for use in calculating risk scores.
Technical Guides
ED Submission Guide and MA Companion Guide
The Encounter Data Submission and Processing Guide is a technical guide that assists with the submission to the EDS. Refer to sections 2.2 and 2.3 for information regarding Unlinked CRRs. The MA Companion Guide provides supplemental instructions for EDR and CRR elements.
MA & Part D Communications Handbook
The MA & Part D Communications Handbook is a technical guide that assists with the submission of data to the Encounter Data Front End System.
The MAO-004 User Guide reviews the filtering process and explanations for the various indicators on the MAO-004 report.
To report an encounter in the X12 837 5010 format, MAOs and other submitters must refer to the national TR3 guides: ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, Health Care Claim: Institutional (837) and ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, Health Care Claim: Professional (837).
Technical Resources
PACE Submission of Risk Adjustment to the EDS Technical Assistance Call – June 13, 2024 (PDF)
The slide deck for the June 13th, 2024, technical assistance call conducted for PACE organizations. It provides a review of the technical instructions for encounter data submissions, submission scenarios, and identifies place of services (POS) code 66 for use on submissions to EDS when the service was provided at the PACE Center.
Encounter Data Technical Assistance Call for PACE Organizations – April 7, 2022 (PDF)
The slide deck for the April 7th, 2022, technical assistance call conducted for PACE organizations.
The slide decks for previous user groups on various topics, including the Rate Announcement, Risk Adjustment for PACE Organizations, and the MAO-004 report.
Other Relevant Resources
Medicare Risk Adjustment Eligible CPT/HCPCS Codes
The list of eligible Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes used for filtering diagnoses from encounter data records.
Model Software and ICD-10 to HCC Mappings
The ICD-9 and ICD-10 mappings of diagnoses to Hierarchical Condition Categories (HCCs) for a model, model software packages for each payment year, and other related documents.
Annual Advance Notice and Rate Announcements
The annual Advance Notice, Rate Announcement, and other related documents for each payment year.
A CMS webpage with information on ICD-10 files and resources.
The 277 Claim Acknowledgement (CA) Edit Lookup provides easy-to-understand descriptions associated with the edit code(s) returned on the 277 CA.