Encounter and Risk Adjustment Program


277CA – Combined Common Edits and Enhancements Module (CCEM) Transaction Set Edits Acknowledgement ReportThis report provides MAOs and other entities feedback on transaction set level and record level adherence to CMS standard syntax rules for submitted files as depicted in the CMS 5010 Edit Spreadsheet.12/29/2020
999 – Functional Group Acknowledgement ReportThe 999 Acknowledgement Report provides MAOs and other entities feedback on functional group and transaction set compliance with TR3-level edits and CMS standard syntax rules for submitted files as depicted in the CMS 5010 Edit Spreadsheet.12/29/2020
Avoiding Common Encounter Data System EditsThis Job Aid provides tips to avoid frequently occurring front-end edits when submitting initial, replacement or void EDRs transactions.12/13/2021
Encounter Data Front End System (EDFES) – Post-Screen Invalid ReportThis report is conditionally generated when an encounter submitter transmits X12 files to EDFES. It provides information resulting from the execution of Medicare Advantage-specific edits at the record and line level on institutional, professional and Durable Medical Equipment (DME) encounter data records as well as chart review records.12/29/2020
Encounter Data Front End System (EDFES) – Pre-Screen Validation ReportThis report is conditionally generated when an encounter submitter transmits X12 files to EDFES. It provides information resulting from the execution of certain edits on the transmitted file.12/29/2020
Encounter Data Overpayment ScenariosThe following job aids provide example scenarios regarding overpayment submissions.3/11/2024
Front-End Risk Adjustment System (FERAS) – Response ReportThis report indicates that a file has been accepted or rejected by the front-end system. This report identifies reasons for rejection.12/29/2020
Health Plan Management System (HPMS) Reports - Encounter Data Report Cards5/14/2025
Health Plan Management System (HPMS) Reports - Submission Performance Reports5/14/2025
Health Plan Management System (HPMS) Reports – Data Exchange ReportsData Exchange Reports inform MAOs and other entities about specific, discernable issues with their submitted encounter data records (EDRs). Using information associated with submitted encounter data records as well as Healthcare Effectiveness Data and Information Set (HEDIS) data, thirteen specific data integrity measures across three key areas are created.12/29/2020
Health Plan Management System (HPMS) Reports – Encounter Data Report CardsEncounter Data Report Cards are transmitted quarterly to each Medicare Advantage contract to provide the contracts with an understanding of their encounter data quality and submission performance.12/29/2020
Health Plan Management System (HPMS) Reports – Submission Performance ReportsThis annual report consists of seven performance metrics and their respective thresholds for MA encounter data. The thresholds are designed to identify performance issues that are substantially below reasonable expectations for submissions.12/29/2020
How To Void and Replace CRRThis guide outlines the steps necessary to populate ANSI ASC X12 837 data elements that effectuate the void or replacement.9/10/2020
How To Void and Replace EDRThis guide explains how to void and replace an encounter data record.9/10/2020
MAO-001 – Encounter Data Duplicates ReportThis report provides information on duplicate data submitted to the Encounter Data Processing System (EDPS). The MAO-001 lists all encounters records that received one of the following duplicate errors: 98300, 98315, 98320, or 98325.12/29/2020
MAO-002 – Encounter Data Processing Status ReportThis Job Aid provides information on the disposition status and error codes for all records and lines for each file that successfully passes all stages of front-end processing and is passed to the Encounter Data Processing System (EDPS).5/26/2022
MAO-002 – Encounter Data Processing Status ReportThis report provides information on the disposition status (either accepted or rejected) and error codes for all records and lines for each file that successfully passes all stages of front-end processing and is passed to the Encounter Data Processing System (EDPS), also called the back-end.12/29/2020
MAO-004 User GuideThis user guide is a comprehensive reference manual for using the MAO-004 Report that is provided by the Centers for Medicare.1/3/2023
MAO-004 – Encounter Data Diagnosis Eligible for Risk AdjustmentThe MAO-004 is a monthly report informing MAOs and other entities of the risk adjustment eligibility of diagnosis data submitted on accepted Encounter Data Records (EDRs) and Chart Review Records (CRRs).12/29/2020
Model Output Report (MOR) PDF and Model Output Data FileThe MOR is a monthly output generated by the Risk Adjustment System (RAS) and reports the Hierarchical Condition Categories (HCCs) used to calculate each beneficiary’s risk scores in each model run.12/29/2020
Model Output Report User GuideThis user guide is a comprehensive reference manual for using the Risk Adjustment Model Output Report (MOR) that is provided by the Centers for Medicare 9/30/2021
New Enrollee Job AidThis guide provides risk adjustment tips relevant to new enrollees.8/2/2017
Risk Adjustment Processing System (RAPS) – Cumulative Plan Activity ReportThis monthly report provides a cumulative summary of the status of submissions by submitter ID and contract number.12/29/2020
Risk Adjustment Processing System (RAPS) – Duplicate Diagnosis Cluster ReportThis report lists diagnosis clusters with a 502 informational edit message - a diagnosis cluster was accepted but not stored because a diagnosis cluster with the same attributes is already stored in the RAPS database.12/29/2020
Risk Adjustment Processing System (RAPS) – Error Frequency ReportsThese reports, available monthly and quarterly, provide a summary of the number of errors generated during the reporting period by error code.12/29/2020
Risk Adjustment Processing System (RAPS) – Monthly Plan Activity ReportThe RAPS Monthly Plan Activity Report provides a summary status of the submissions by submitter ID and contract number.12/29/2020
Risk Adjustment Processing System (RAPS) – Return FileThe RAPS Return File includes all the records and diagnosis clusters submitted by the MAO or other entity. It identifies any errors during the RAPS process.12/29/2020
Risk Adjustment Processing System (RAPS) – Transaction Error ReportShorter than the RAPS Return File, the RAPS Transaction Error Report lists only those ‘CCC’ records that contain errors, causing one or more diagnosis clusters to be rejected.12/29/2020
Risk Adjustment Processing System (RAPS) – Transaction Summary ReportThe RAPS Transaction Summary Report provides a summary of RAPS data submissions for each file submitted.12/29/2020
TA1 – Interchange Acknowledgement ReportThe TA1 Interchange Acknowledgement Report provides syntax editing for Interchange envelope conformance (ISA/IEA level).12/29/2020