1. Risk Adjustment User Group Session
2006/2007 Monthly
Risk Adjustment User Group Session
A training initiative presented by
OCTOBER 2007 1

2. Welcome to the October User Group
Introduction
Payment Process
Data Validation
Operations Update
Training Update
Questions and Answers
Closing 2

3. INTRODUCTION 3

4. Introduction User Group Process All attendees must pre-register
Panel will answer questions during the Q&A portion of the session
Session will last for one hour
Q&A document and session notes will be available within 2 weeks after the session
Session slides will be available by the Tuesday before the session 4

5. PAYMENT PROCESS 5

6. Payment Process Medicaid Eligibility 2008 Initial Year Sweep Date
September 21, 2007
2009 Payment
Original Reason for Entitlement (OREC) Values 6

7. DATA VALIDATION 7

8. Data Validation Calendar Year 2006
August 17, 2007 was the Medical record submission deadline
MA organizations must immediately submit any outstanding medical records
Missing medical records
Represent a violation of 42 CFR §
AND
Will be considered for payment adjustments 8

9. Data Validation (cont’d)
Calendar Year 2005
IVC and SVC medical record review results merged
Data undergoing analysis and quality assurance
CMS anticipates distributing results to selected organizations in late fall of 2007 9

10. Data Validation (cont’d)
Calendar Year 2004
Mid to late October 2007
Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample 10

11. OPERATIONS UPDATE 11

12. Submission Deadline
Next submission deadline for dates of service 01/01/2006 through 12/31/2006:
January 31, 2008
Submit all outstanding claims
Research and correct errors that can be corrected
Resubmit 12

13. Error Codes
For the last quarter (July – Aug – Sept), the highest percentage of error codes were:
408 = 5.66%
409 = 5.23%
410 = 8.67%
408 – Service From Date is not within MA organization enrollment period.
409 – Service Through Date is not within MA organization enrollment period.
410 – Beneficiary is not enrolled in plan on or after Service From Date. 13

14. TRAINING UPDATE 14

15. Training Update Enrollment and Payment Training
October 2007 Training
Now Registering
Enrollment and Payment Training
October 30
Risk Adjustment Training
October 31 15

16. 2007/2008 Monthly Training Schedule* *For detailed information
Training Update
2007/2008 Monthly Training Schedule*
*For detailed information
and to
register online
log on to 16

17. QUESTIONS AND ANSWERS 17

18. CLOSING 18

19. Resources
Sean Creighton (Director, Division Risk Adjustment Operations)
Henry Thomas (Training, Project Officer)
Lateefah Hughes (Data Validation, Team Lead)
Louis Johnson (FERAS, Risk Adjustment Coordination)
Chanda McNeal (Payment Issues)
LTC
CSSC 19