1. Risk Adjustment User Group
July 2008

2. Welcome to the July User Group
Introduction
Payment Process
Operations Update
Data Validation
Technical Assistance 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 (PART A-ONLY OPTION)
Effective for 2006 payments, organizations may elect to have CMS determine payments for all “Part A-only” enrollees using either new enrollee factors or full risk adjustment factors.
Plans may not elect to move some eligible “Part A-only” enrollees into full risk adjustment, while retaining others as new enrollees.
Once elected, this option will remain turned “on” until CMS is otherwise notified prior to August 31st of any successive year.
This option is applied during reconciliation for a payment year only (i.e., it will not be applied prospectively).
Plans interested in this option must contact by August 31st.

8. PAYMENT PROCESS (PART A-ONLY OPTION TABLE)
Beneficiary entitled under Part A
Beneficiary enrolled in Part B
0 – 11 months
>= 12 months
New enrollee factors
New enrollee of full risk factors
Full risk factors

9. DATA VALIDATION

10. DATA VALIDATION Calendar Year 2007 Calendar Year 2006

11. OPERATIONS UPDATES

12. Connecting to the FERAS
OPERATIONS
Connecting to the FERAS
To establish an IP connection with the FERAS, you must be connected to the Medicare Data Communications Network (MDCN), which is provided by AT&T Global Network Services. The MDCN is the secure network linking the Risk Adjustment data processing entities.
If you are not connected to the MDCN, please contact AT&T at

13. OPERATIONS
All submitters with IP network access have been authorized to connect to the FERAS.
In order to submit claims to the FERAS via the MDCN, you must be enrolled with the CSSC Operations. If you are not enrolled, please contact the CSSC Operations Help Line at (877) Once enrolled with the CSSC, to submit and retrieve data electronically, you will receive a Submitter ID and a password.

14. TECHNICAL ASSISTANCE
UPDATES

15. TECHNICAL ASSISTANCE UPDATES
2008 Monthly
Technical Assistance Sessions
Enrollment & Payment Session
July 30th
Due to Regional Technical Assistance Sessions, the August Monthly Technical Assistance Session is canceled
Register today at

16. REGIONAL TECHNICAL ASSISTANCE SESSIONS
Limited Availability…Register Soon!
CHICAGO, IL
August 11 – August 14
LAS VEGAS, NV
registration is closed
NEW ORLEANS, LA
September 9 – September 10

17. TECHNICAL ASSISTANCE UPDATES
*For detailed information
and to
register online
log on to
Technical Assistance
Registration Service Center

18. QUESTIONS & ANSWERS

19. CLOSING

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