Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Reports
Program Area: Risk Adjustment (RA)
Question: What is the timeline for the informal discrepancy reporting process and when is the deadline for submitting identified discrepancies?
Answer: There is no timeline for the informal discrepancy reporting process; however, the Centers for Medicare & Medicaid Services (CMS) suggest that issuers submit informal discrepancies as soon as the discrepancy is identified. The formal discrepancy process begins in March and May. Issuers will have 30 days to submit a discrepancy report for interim reports and 15 days to submit a discrepancy report for final reports. In order for an issuer to reserve appeal rights, the issuer must submit a formal discrepancy report.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 19, 2015
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