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

Issue Date: August 13, 2020

Program Area: Risk Adjustment (RA)

Question: Can issuers file a discrepancy report for bill type codes rejected due to ineligibility in the Risk Adjustment (RA) program?

Answer: No, issuers should not file a discrepancy report for rejected bill type codes unless the issuer determines that an RA acceptable bill type was rejected in error. The acceptable bill type codes for RA are 111, 117, 131, 137, 711, 717, 761, 767, 771, 777, 851 and 857 and professional claims with at least one RA CPT code. The Centers for Medicare & Medicaid Services (CMS) provided a list of acceptable bill type codes for RA in the RA Risk Scores Part One (1) Computer-based Training (CBT),located under the RA program area at https://www.regtap.info/reg_librarye.php?i=2141&type=v in the REGTAP Library.

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