Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: Can the Centers for Medicare & Medicaid Services (CMS) confirm that the dates of services associated with diagnosis codes on claims will be checked against the enrollee's enrollment period?
Answer: Yes, dates of service on claims will be assessed against enrollment periods for the enrollee ID that are submitted on the enrollment file, and plan enrollment periods to determine acceptability for risk adjustment calculations.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 25, 2019
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