4. Miscellaneous FAQs
Miscellaneous FAQs
Q: If there is a discrepancy on a Monthly Membership Report, who should be contacted?
A: You may contact the MMA Help Desk at 1-800-927-8069.
Q: Are Hospice and SNF claims included in the risk adjustment data that MA Organizations submit?
A: Hospice and SNF data are not included in the risk adjustment model.
Q: If an MA Organization is unclear about how to complete the Submitter Application form and the EDI agreement, who should be contacted?
A: MA Organizations should call the CSSC Helpline at 1-877-534-2772. A customer service representative will guide the MA Organization through the process of completing the forms.
Q: How can MA Organizations determine to whom the Submitter Application and EDI agreement forms were sent and how can MA Organizations discover whether the CSSC has these signed agreements on file?
A: MA Organizations may call a CSSC customer service representative at 1-877-534-2772 to obtain this information.
Q: Can the reconciliation payment date be included on the Annual Risk Adjustment Submission Timetable?
A: Future reconciliation payment dates have not been determined; therefore, this information will not be included on the submission timetable at this time.
Q: Can MA Organizations submit denied claims?
A: Yes, information should be sent whether or not the claim is paid. But, if the MA Organization denies a claim due to inaccuracies in core data elements (i.e. from date, through date, diagnosis); the data should not be submitted until the correct information is verified.
Q: When submitting data for a beneficiary who was previously enrolled with another MA Organization, will the resulting report be returned to the current MA Organization or the previous MA Organization?
A: Reports will be returned to the MA Organization that submitted the data.