Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: How will the Centers for Medicare & Medicaid Services (CMS) assign a claim that has dates of service spanning two (2) benefit years (e.g., 12/26/2014 to 1/10/2015) for the Risk Adjustment (RA) program?
Answer: Although claims that encompass more than one (1) benefit year are submitted to the External Data Gathering Environment (EDGE) server, only claims that have a Date of Service Through date within the benefit year (12/31, 2014) are eligible for RA calculations.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 14, 2015
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