Will the MAO-004 report reflect diagnosis codes that are not risk adjustment eligible with a disallowed flag?


Yes, the MAO-004 report will indicate diagnoses that do not pass the CMS filtering logic with a “D”, in the allowed/disallowed flag field, meaning the diagnoses were reported but are disallowed for risk adjustment. The allowed/disallowed flag field is included to help MAOs or other entities determine which records accepted on the MAO-002 report passed the CMS filtering logic as reported on the MAO-004 report

Source: CMS HPMS Memo with subject “Phase III Version 3 MAO-004 Report Release Date and Announcement Regarding Final Encounter Data Deadlines for Payment Years 2016-17” (December 20, 2017)

Last Updated: 12/20/2017