Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 31, 2014

Program Area: Risk Adjustment (RA)

Question: Are denied medical claims accepted for the commercial risk adjustment program, and what documentation provides guidance on denied medical claims?

Answer: In accordance with the HHS Notice of Benefits and Parameters for 2014 (78 FR 15499, March 11, 2013) denied claims are not acceptable.

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