Risk Adjustment for EDS and RAPS User Group - April 27, 2017

Risk Adjustment for EDS and RAPS User Group - April 27, 2017

Table of Contents

• Slide 5 - MOR, Record Types, Which MOR reports will use new record types, PCUG Updates related to MOR record types
• Slides 7-11 - MAO-004, Phase III Information, File Naming Convention, Key fields in MAO-004 report layout
• Slides 12-13 - MAO-004, Phase II Information, File Naming Convention, Key fields in MAO-004 report layout
• Slide 14 - Replacement and Void Logic Chart Review Records, Linked CRRs
• Slide 15 - MAO-004, Diagnosis Filtering Logic
• Slide 16 - MAO-004, Terminated / consolidated contracts
• Slide 17 - MAO-004, Diagnoses included on MAO-002 but not on MAO-004
• Slides 18-20 - Medicaid Status Data File, Overview, Where to access, examples of Medicaid status
• Slide 23 - Risk Adjustment Overpayment Reporting Module, Overview
• Slides 25-27 - Monitoring & Compliance of Encounter Data, Overview, Introduction to monitoring and compliance goals and projects
• Slides 29-33 - EDS Submission Overview, Flow charts for EDS & RAPS processing, X12 Submission Envelope
• Slide 35 - EDS Reports Overview
• Slide 36 - Report Restoration
• Slide 37 - MAO-004, Accessing MAO-004
• Slides 38-42 - EDFES Reports, Description, File Naming Convention
• Slides 38-42 - EDPS Reports, Description, File Naming Convention
• Slides 44-48 - TA1 Acknowledgement Report, Overview, Structure, error resolution
• Slides 49-54 - 999 Acknowledgement Report, Overview, Structure, error resolution
• Slides 55-56 - CMS 5010 Edits Spreadsheet, Overview, Location, description
• Slides 57-63 - 277CA Acknowledgement Report, Overview, How to read 277CA, structure, error resolution
• Slides 65-75 - MAO-001, Report Layout
• Slides 65-75 - MAO-002, Report Layout