1. Risk Adjustment User Group
June 2009

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

3. INTRODUCTION

4. INTRODUCTION User Group Process All attendees must pre-register
It is only necessary to register once
Retain unique PIN for all sessions
Session will last for one hour
Session slides will be available by the Tuesday before the session
Panel will answer questions during the Q&A portion of the session

5. INTRODUCTION
The 2008 monthly Risk Adjustment User Group Q & A and Notes documents are posted at the CSSC Operations website.
Please continue to review the website for updates to this information.

6. PAYMENT PROCESS

7. PAYMENT PROCESS Prior to transition 38% response rate Post transition
77% resolved in March
67% resolved in April
57% resolved in May

8. PAYMENT PROCESS CLARIFICATION
Question:
If a member transfers from another Medicare Advantage plan, can the current plan submit dates of service that pre-date the member’s eligibility in the new plan?
Example: If a Member joins a MA Organization (Plan A) on August 1, 2007, can “Plan A” submit dates of service from January 2007 through July 2007, or only dates of service after August 1, 2007.

9. PAYMENT PROCESS Answer:
Plans may only submit for beneficiaries who are enrolled in their plan on the DOS.
If a beneficiary is not enrolled in the plan on the DOS included in the diagnosis cluster, the plan will receive a 408 and/or 409 error code on the RAPS reports.
NOTE:
Plan A can only submit a date with DOS after August 1, 2007

10. DATA VALIDATION

11. DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008)
Analyses in progress
National Sample (notified Dec. 3, 2008)
Medical Record Review complete
Targeted Sample (notified Nov. 10, 2008)
Instructions Packet to be distributed
Selected plans to be notified via when packet is released
Plans will have 12 weeks to submit medical records
Random Sample
To be implemented

12. INTRODUCTION Q&A Resources
User Group Calls cover 2 risk adjustment areas: Payment Operations and Data Validation.
On the calls, subject matter experts are available from each area to answer questions.
To submit questions outside of User Group:
for Payment Operations
for Data Validation

13. OPERATIONS UPDATES

14. Operations
Plans can now access the 2008 Risk Adjustment Participant Guide, Color Slides, Resource Guide, and the Job Aids on the CSSC Operations website at:

15. OPERATIONS
If experiencing technical problems submitting data, check the CSSC Operations website under the System Status page for messages and updates on the RAPS processing status:

16. OPERATIONS Report Distribution
Reports are sent to the mailbox as identified on the submitter application.

17. OPERATIONS
Test Environment
Submissions

18. TECHNICAL ASSISTANCE
UPDATES

19. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
July 15, 2009

20. QUESTIONS & ANSWERS

21. CLOSING

22. RESOURCES
Sean Creighton (Director, Division Risk Adjustment Operations)
Henry Thomas (Training, Project Officer)
Louis Johnson (FERAS,GTL)
Chanda McNeal (RAS Payment)
Payment Research
Lateefah Hughes (RADV)
Ann Marshall (RADV)
LTC
CSSC