How can MAOs submit questions regarding MAO-004 reports that they did not receive, but believe they should have?


MAOs and other entities can submit questions regarding missing MAO-004 Reports to If asking about specific records versus whole reports, please include the related Internal Control Numbers (ICNs) of the encounter(s) in question. Prior to submitting questions, please verify that reports are not in your established File Transfer Protocol (FTP) mailbox or are not available through the Medicare Advantage Prescription Drug User Interface (MARx UI).
If you believe an Encounter Data Record (EDR) is missing from the MAO-004, please check to make sure the EDR meets the criteria below.
  • Does the data in question have a date of service of January 2014 or later?
  • Is the encounter data record accepted at the header level by Encounter Data System (EDS), as reported on the MAO-002 report?
  • Does the encounter data record pass the CMS published filtering logic for each specific encounter type under consideration– Professional, Outpatient, Inpatient?
If an encounter data record meets these criteria, all diagnoses on the record will be indicated as either allowed or disallowed and will also be designated as add, delete, or blank. Diagnoses marked as allowed and either add or blank are considered eligible for risk adjustment, however, not all eligible diagnoses map to an Hierarchical Condition Category (HCC) in the risk adjustment models.

Source: User Group Q&A Documentation from January 19, 2017

Last Updated: 01/19/2017