Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Reports
Program Area: Risk Adjustment (RA)
Question: What will be in the Risk Adjustment (RA) risk score report provided by the Centers for Medicare & Medicaid Services (CMS) to the issuer?
Answer: There are two outbound risk adjustment risk score reports. The Risk Adjustment Risk Score Summary (RARSS) Report is available to both CMS and issuers. The Risk Adjustment Risk Score Detail (RARSD) Report is available only to issuers and is not available to CMS. The RARSS Report notifies CMS and issuers about issuer and plan level summary values from the risk score. The RARSD Report contains detailed enrollee claim information used to calculate the individual risk score on the External Data Gathering Environment (EDGE) server. For additional information, the RA program area has published a computer-based training (CBTs) located here RA Reports and Proration https://www.regtap.info/reg_librarye.php?i=2313&type=t the REGTAP library.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 28, 2019
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.