Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: If issuers submit claim data with a paid date after March 31, 2015 to their EDGE servers before April 30, 2015, will the Risk Adjustment (RA) software include the claim data in RA calculations for the 2014 benefit year?
Answer: RA calculations will include claims with dates of service between January 1, 2014 and December 31, 2014 regardless of the paid date on the claim. For additional information, please review the EDGE Server Business Rules (ESBR), located under the Distributed Data Collection (DDC) program area at https://www.REGTAP.info in the REGTAP Library.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 09, 2015
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