Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: If a policy member has been effective for one (1) month, is the reported premium amount still required to be greater than zero for the subscriber?
Answer: Yes. If reporting for one (1) or more months, the subscriber premium should be the monthly premium. For additional information, the Distributed Data Collection (DDC) program area has published the EDGE Server Business Rules document located here https://www.regtap.info/reg_librarye.php?i=2673 in the REGTAP library.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 22, 2019
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