Risk Adjustment for EDS and RAPS User Group - July 19, 2018

Slide 9 - CMS-HCC Risk Adjustment Model, Medicaid Status, MARx uses Medicaid Status to determine RAF
Slide 10 - CMS-HCC Risk Adjustment Model, Dual Status, Definition of full and partial benefit dual eligible
Slides 11-13 - MMR, Medicaid Status, Medicaid status is used to calculate payment reported on the MMR
Slides 14-18 - Medicaid Status Data File, Overview, Information provided, time period used
Slides 22-23 - MAO-004, Phase III report errors, CMS will address the discrepancies with risk score reruns
Slides 26-27 - ED & RAPS Submission, Submission and Processing Guide, Consolidated ED guidance from 2012-2017
Slide 28 - ED & RAPS Submission, Communications Handbook, Describes how to connect to CMS systems to transfer and receive files
Slide 29 - ED & RAPS Submission, Technical Assistance Website, Describes content reorganization
Slides 35-38 - MOR, Overview and fields
Slide 39 - MOR, Accessing MORs, Plans will access MORs through Gentran or TIBCO
Slide 40 - MOR, Blended Risk Scores, Indicates origin of diagnoses in risk score calculation
Slides 41-44 - MOR, Record Types
Slide 45 - MOR, Timing, Monthly MOR reports are sent for each payment month
Slide 47 - MAO-004, PY 2017 Interim Risk Payment, 2017 payment was calculated with MAO-004 Phase III version 2
Slide 48 - Risk Adjustment Model Overview, Risk score calculation, Risk scores from the interim 2017 final model include diagnoses from January 2018

Last Updated: 07/19/2018

Table of Contents