Encounter and Risk Adjustment Program (Part C)


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Encounter and Risk Adjustment Program (Part C) Articles

2011 RAPS Compliant Error CodesIndustry Update QA - January 19, 2011EDPS Bulletin 17 - October 15, 2012Encounter Data Processing Status Report - Record File Layout - February 2, 2012EDPS Bulletin 31 - July 3, 2013EDPS Bulletin 20 - December 17, 2012Appendix 4C 277CA Acknowledgment Report Key SegmentsRisk Adjustment for EDS and RAPS User Group Q&As - July 21, 20162014 Encounter Data National Technical Assistance Job Aids - August 14, 2014Risk Adjustment for EDS and RAPS User Group - May 18, 2017Encounter Data Newsletter – Volume 4, Issue 1Appendix 3A MA Companion Guide: CMS' Supplemental Instructions for EDR & CRR Data ElementsRisk Adjustment for EDS and RAPS User Group - August 25, 2016Encounter Data Processing Status Report - Sample Formatted Report - February 2, 20122011 Risk Adjustment Payment Reconciliation WorkbookEDS Front-End Testing LetterEncounter Data Processing Status Report2003 Presentation SlidesEncounter Data Companion Guide - Professional November 2013 ReleaseProfessional January 2012 ReleaseRisk Adjustment for EDS and RAPS User Group - February 16, 2017Encounter Data User Group – May 16, 2013PACE Testing LetterPACE Front-End Industry Testing PackagePACE Test Case Specifications - InstitutionalPACE Test Case Specifications - ProfessionalEncounter Data User Group Q&As - November 29, 2012Encounter Data User Group – January 10, 2013Encounter Data User Group Q&As – March 29, 2012Encounter Data User Group – August 30, 2012Encounter Data User Group – October 18, 2012Encounter Data User Group - June 21, 20122012 Risk Adjustment Regional Technical Assistance – Risk Score Calculation WorkbookEncounter Data User Group Q&As - May 24, 20122012 Payment Regional Technical Assistance – Report Reconciliation Boot Camp Workbook2013 Risk Adjustment 101 Participant GuideEDPS Bulletin 4 – April 11, 2012Encounter Data User Group Q&As – March 7, 2013Encounter Data User Group Q&As - April 12, 2012Encounter Data User Group - January 12, 2012Appendix 4C 277CA Acknowledgment Report Key SegmentsEDPS Bulletin 26 – April 11, 20132012 Risk Adjustment Regional Technical Assistance Resource GuideEncounter Data User Group - April 24, 2014Risk Adjustment for EDS and RAPS User Group - October 26, 2017Encounter Data User Group – April 4, 2013Appendix 4B 999 Acknowledgement Report Key SegmentsEncounter Data Newsletter – Quarter 3EDPS Bulletin 11 - May 30, 2012Encounter Data User Group Q&As - November 17, 2011EDPS Bulletin 15 - July 19, 2012FERAS User GuideMAO-001 Encounter Data Duplicates Report - Effective March 30, 2018Encounter Data Testing Schedule - RevisedPACE Testing LetterEncounter Data End-to-End Testing TipsBulletin for EDS and RAPS - September 2015Appendix 4B 999 Acknowledgement Report Key SegmentsAppendix 5B MAO-002 Report LayoutAppendix 4A TA1 Acknowledgement Report Key SegmentsAppendix 5A MAO-001 Report LayoutEncounter Data Submission and Processing GuideAppendix 3A MA Companion Guide: CMS' Supplemental Instructions for EDR & CRR Data ElementsAppendix 3C MBI Edits for ED and RAPS DataEncounter Data Submission and Processing GuideAppendix 4D Deactivated EditsAppendix 4A TA1 Acknowledgement Report Key SegmentsAppendix 3C MBI Edits for ED and RAPS DataAppendix 3B Crosswalk from Retired Minimum Data Element List to Appendix 3A MA Companion GuideEDPS Bulletin 2 – March 28, 2012EDPS Bulletin 1 - March 21, 2012EDPS Bulletin 3 - April 4, 2012EDPS Bulletin 6 – April 25, 2012EDPS Bulletin 5 – April 18, 2012EDPS Bulletin 7 – May 2, 2012EDPS Bulletin 9 - May 16, 2012EDPS Bulletin 10 – May 23, 2012EDPS Bulletin 8 – May 9, 2012EDPS Bulletin 13 - June 27, 2012EDPS Bulletin 12 - June 13, 2012EDPS Bulletin 14 - July 11, 2012Summary Notes Industry Update - January 19, 2011EDPS Bulletin 16 – September 17, 2012Encounter Data Industry Call - October 27, 2011EDPS Bulletin 19 – November 27, 2012EDPS Bulletin 18 – November 7, 2012Summary Notes Industry Update - March 16, 2011EDPS Bulletin 23 - February 27, 2013EDPS Bulletin 21 – January 16, 2013EDPS Bulletin 22 - January 30, 2013Encounter Data Industry Call - April 20, 2011EDPS Bulletin 25 – March 27, 2013EDPS Bulletin 27 - April 25, 2013EDPS Bulletin 24 - March 13, 2013EDPS Bulletin 28 - May 9, 2013Encounter Data Industry Call - February 2, 2012Encounter Data Industry Call Q&As - February 2, 2012EDPS Bulletin 30 - June 19, 2013Encounter Data Newsletter - Quarter 3Encounter Data Newsletter - Quarter 4Encounter Data Newsletter - Quarter 2Encounter Data Newsletter - Quarter 1Encounter Data Newsletter – Quarter 4Encounter Data Newsletter - Quarter 2Encounter Data Newsletter - Quarter 1Encounter Data Newsletter - Quarter 2Encounter Data Newsletter – Quarter 1Encounter Data Newsletter – Quarter 3Newsletter for EDS and RAPS - March 2015Newsletter for EDS and RAPS - September 2015Newsletter for EDS and RAPS - November 2014Risk Adjustment for EDS and RAPS User Group - September 28, 2017Risk Adjustment for EDS and RAPS User Group - August 17, 20172015 Risk Adjustment for EDS and RAPS Webinar Q&As – February 19, 20152014 Encounter Data 101 Q&As - August 7, 20142014 Risk Adjustment for EDS and RAPS Webinar – December 18, 20142015 Risk Adjustment for EDS and RAPS Webinar - February 19, 20152012 Encounter Data Regional Technical Assistance Job Aid – DME HCPCS Worksheet2014 Encounter Data 101 - August 7, 20142014 Encounter Data National Technical Assistance Slides - August 14, 20142012 Encounter Data Regional Technical Assistance Participant Guide2012 Encounter Data Regional Technical Assistance Presentation Slides2011 Encounter Data Participant Guide2011 Encounter Data Slide Presentation2014 Risk Adjustment Webinar - July 1, 20142014 Encounter Data National Technical Assistance Webinar Q&As - August 14, 20142014 Risk Adjustment Job Aids - July 1, 20142015 Risk Adjustment for EDS and RAPS Webinar Q&As - June 11, 20152014 Risk Adjustment for EDS and RAPS Webinar Q&As - December 18, 20142015 Risk Adjustment for EDS and RAPS Webinar - June 11, 2015Risk Adjustment for EDS and RAPS User Group QandAs - February 16, 2017Risk Adjustment for EDS and RAPS User Group Q&As - March 23, 2017Risk Adjustment for EDS and RAPS User Group - June 15, 2017Risk Adjustment for EDS and RAPS User Group - July 20, 2017Encounter Data User Group - May 2, 2013Risk Adjustment for EDS and RAPS User Group - April 27, 2017Encounter Data User Group - November 03, 2011Encounter Data User Group Q&As – May 2, 2013Encounter Data User Group - June 13, 2013Encounter Data User Group Q&As – July 18, 2013Encounter Data User Group Q&As – June 27, 2013Encounter Data User Group - July 18, 2013Encounter Data User Group - June 26, 2014Encounter Data User Group - January 16, 2014EDS 101 User Group Q&As – August 7, 2014Encounter Data User Group - November 21, 2013Risk Adjustment for EDS and RAPS User Group Q&As - June 23, 2016Risk Adjustment for EDS and RAPS User Group - November 17, 2016Risk Adjustment for EDS and RAPS User Group - September 29, 2016Risk Adjustment for EDS and RAPS User Group - January 19, 2017Risk Adjustment for EDS and RAPS User Group Q&As - August 25, 2016Risk Adjustment for EDS and RAPS User Group - October 20, 2016Risk Adjustment for EDS and RAPS User Group Q&As - November 17, 2016Risk Adjustment for EDS and RAPS User Group - March 23, 2017Risk Adjustment for EDS and RAPS User Group Q&As - January 19, 2017Encounter Data User Group Q&As – April 18, 2013Encounter Data User Group – April 26, 2012Encounter Data User Group - February 7, 2013Encounter Data User Group - March 29, 2012Encounter Data User Group - April 12, 2012Encounter Data User Group - February 21, 2013Encounter Data PACE Work Group – March 21, 2012Encounter Data User Group Q&As -February 21, 2013Encounter Data User Group Q&As – March 15, 2012Encounter Data User Group – March 15, 2012Encounter Data User Group - March 7, 2013Encounter Data User Group Q&As - February 16, 2012Encounter Data User Group Q&As - April 4, 2013Encounter Data User Group Q&As - January 12, 2012Encounter Data User Group - February 16, 2012Encounter Data User Group - December 01, 2011Encounter Data User Group - December 15, 2011User Group Q&As - December 15, 2011Encounter Data User Group Q&As – March 21, 2013User Group Q&As - December 01, 2011User Group - November 17, 2011Encounter Data User Group – March 21, 2013User Group Q&As - November 03, 2011Encounter Data User Group – April 18, 2013Encounter Data User Group Q&As - April 26, 2012Encounter Data User Group - May 24, 2012Encounter Data User Group - August 21, 2012Appendix 3B Crosswalk from Retired Minimum Data Element List to Appendix 3A MA Companion GuideEncounter Data User Group Q&As - June 7, 2012Encounter Data User Group - June 7, 2012Encounter Data User Group Q&As - June 21, 2012Encounter Data User Group Q&As - August 21, 2012Encounter Data PACE User Group - August 28, 2012Encounter Data User Group - October 4, 2012Encounter Data User Group Q&As - October 4, 2012Encounter Data User Group Q&As – August 30, 2012Encounter Data User Group – November 15, 2012Encounter Data User Group Q&As – October 18, 2012Encounter Data User Group Q&As - November 15, 2012Encounter Data User Group Q&As – December 20, 2012Encounter Data User Group - November 29, 2012Encounter Data User Group - December 20, 2012Encounter Data User Group Q&As - January 24, 2013Encounter Data User Group Q&As – January 10, 2013Encounter Data User Group – January 24, 2013Encounter Data User Group Q&As - May 10, 2012Encounter Data User Group Q&As – February 7, 2013Encounter Data User Group – May 10, 20122016 Risk Adjustment for EDS and RAPS Webinar Slides – June 23, 20162012 Risk Adjustment Regional Technical Assistance Participant Guide2013 Risk Adjustment 101 Presentation Slides2012 Risk Adjustment Regional Technical Assistance Job Aids2012 Payment Regional Technical Assistance Presentation Slides2012 Risk Adjustment Regional Technical Assistance Presentation Slides2012 Payment Regional Technical Assistance Participant Guide2012 Enrollment Regional Technical Assistance Materials2012 Payment Regional Technical Assistance Job Aid - TRCsEncounter Data Newsletter – Volume 4, Issue 22012 Enrollment Regional Technical Assistance Job Aids2012 Enrollment Regional Technical Assistance Resource GuideEDPS Bulletin 29 – June 7, 2013Appendix 4D Deactivated EditsAppendix 5A MAO-001 Report LayoutAppendix 5B MAO-002 Report Layout2008 Participant Guide2011 Risk Adjustment Payment Reconciliation Additional Exercises Answer Key2007 ExercisesEncounter Data Minimum Data Elements2006 July Risk Adjustment Training Materials Revisions Letter2006 February Participant Guide2007 Presentation Slides2007 Participant Guide2007 Resource Guide2011 MARx UI Step-by-Step Guide2011 Payment Slide Presentations2006 February Presentation Slides2006 July Presentation Slides2011 Payment Participant Guide2006 July Participant Guide2007 Job Aides2006 July Resource Guide2007 Answer Keys2008 Presentation Slides2008 Enrollment & Payment Technical Assistance Guide2008 Job Aides2011 Enrollment Slide Presentations2011 Risk Adjustment Payment Reconciliation Answer Key2011 Risk Adjustment Slide PresentationsEncounter Data Companion Guide – Institutional March 2016 ReleaseEncounter Data Companion Guide – Professional March 2016 ReleaseEncounter Data Companion Guide - Professional (DME) July 2016 ReleaseEncounter Data Companion Guide - Institutional July 2016 ReleaseEncounter Data Companion Guide – Professional (DME) March 2016 ReleaseEncounter Data Companion Guide - Professional July 2016 ReleaseEDPS Bulletin 32 - July 25, 20132004 Participant Guide2003 June RA Regional Training Q&As2004 Presentation Slides2005 Presentation Slides2005 Resource Guide2003 Regional Office Contacts2004 August Special Training Session2003 Resource GuideEDFES User Guide2004 Resource Guide2004 Risk Adjustment Training Materials Revisions Letter2006 February Resource Guide2006 February Risk Adjustment Training Materials & Revisions Log2003 Risk Adjustment Training Materials Revisions Letter2005 Risk Adjustment Training Materials Revisions Letter2005 Regional Training Video Contact List2003 Participant GuideEDPPPS Proposed Edit Comments ToolMAO-001 Encounter Data Duplicates ReportEDPPPS Proposed Edit Comments Letter2005 Participant GuideEDPPPS Proposed Edits ToolMAO-002 Report Notification2008 Resource GuideRisk Adjustment for EDS and RAPS User Group Q&As - April 27, 2017Encounter Data Companion Guide - Professional (DME) March 2015Encounter Data Companion Guide - Professional November 2014Encounter Data Companion Guide – Professional June 2015 ReleaseEncounter Data Companion Guide - Institutional December 2015Encounter Data Companion Guide – Professional (DME) June 2013 ReleaseEncounter Data Companion Guide – Professional (DME) June 2015 ReleaseEncounter Data Companion Guide – Institutional June 2015 ReleaseEncounter Data Companion Guide - Professional December 2015Encounter Data Companion Guide - Professional (DME) December 2015Encounter Data Companion Guide - Institutional November 2014Encounter Data Companion Guide - Professional (DME) November 2014Encounter Data Companion Guide – Institutional August 2012 ReleaseEncounter Data Companion Guide - Professional September 2012 ReleaseEncounter Data Companion Guide - Institutional September 2012 ReleaseEncounter Data Companion Guide - Professional (DME) September 2012 ReleaseEncounter Data Companion Guide – Professional October 2012 ReleaseEncounter Data Companion Guide – Professional (DME) October 2012 ReleaseEncounter Data Companion Guide – Professional (DME) November 2012 ReleaseEncounter Data Companion Guide – Professional November 2012 ReleaseEncounter Data Companion Guide – Institutional October 2012 ReleaseEncounter Data Companion Guide – Institutional November 2012 ReleaseEncounter Data Companion Guide – Institutional December 2012 ReleaseEncounter Data Companion Guide – Professional December 2012 ReleaseEncounter Data Companion Guide – Professional (DME) December 2012 ReleaseEncounter Data Companion Guide – Professional (DME) January 2013 ReleaseEncounter Data Companion Guide – Professional (DME) February 2013 ReleaseEncounter Data Companion Guide – Professional January 2013 ReleaseEncounter Data Companion Guide – Institutional January 2013 ReleaseEncounter Data Companion Guide – Professional February 2013 ReleaseEncounter Data Companion Guide – Institutional February 2013 ReleaseEncounter Data Companion Guide - Professional (DME) March 2013 ReleaseEncounter Data Companion Guide – Professional September 2014 ReleaseEncounter Data Companion Guide - Professional March 2013 ReleaseEncounter Data Companion Guide – Institutional September 2014 ReleaseEncounter Data Companion Guide - Institutional March 2013 ReleaseEncounter Data Companion Guide – Professional April 2013 ReleaseEncounter Data Companion Guide – Professional (DME) April 2013 ReleaseEncounter Data Companion Guide - Institutional May 2013 ReleaseEncounter Data Companion Guide – Professional (DME) May 2013 ReleaseEncounter Data Companion Guide – Institutional April 2013 ReleaseEncounter Data Companion Guide - Professional May 2013 ReleaseEncounter Data Companion Guide – Professional August 2012 ReleaseEncounter Data Companion Guide – Institutional December 2013 ReleaseEncounter Data Companion Guide – Professional January 2014 ReleaseEncounter Data Companion Guide – Institutional January 2014 ReleaseEncounter Data Companion Guide - Professional (DME)February 2014 ReleaseEncounter Data Companion Guide - Professional February 2014 ReleaseEncounter Data Companion Guide - Institutional February 2014 ReleaseEncounter Data Companion Guide - Professional April 2014 ReleaseEncounter Data Companion Guide – Professional May 2014 ReleaseEncounter Data Companion Guide - Institutional April 2014 ReleaseEncounter Data Companion Guide – Institutional May 2014 ReleaseEncounter Data Companion Guide – Professional (DME) May 2014 ReleaseEncounter Data Companion Guide – Institutional July 2014 ReleaseEncounter Data Companion Guide – Professional (DME) July 2014 ReleaseEncounter Data Companion Guide – Professional July 2014 ReleaseEncounter Data Companion Guide - Professional June 2013 ReleaseProfessional September ReleaseInstitutional September ReleaseInstitutional December ReleaseEncounter Data User Group Q&As - May 16, 2013Professional November ReleaseInstitutional November ReleaseProfessional December ReleaseUser Group - November 03, 2011Institutional January 2012 ReleaseProfessional February 2012 ReleaseInstitutional February 2012 ReleaseInstitutional May 2012 ReleaseProfessional May 2012 ReleaseEncounter Data Companion Guide - Professional (DME) June 2012 ReleaseEncounter Data Companion Guides - Institutional June 2012 ReleaseEncounter Data Companion Guide – Professional (DME) August 2012 ReleaseEncounter Data Companion Guides - Professional June 2012 ReleaseEncounter Data Companion Guide – Professional December 2013 ReleaseEncounter Data Companion Guide – Professional (DME) October 2013 ReleaseEncounter Data Companion Guide - Institutional June 2013 ReleaseEncounter Data Companion Guide – Professional July 2013 ReleaseEncounter Data Companion Guide – Professional (DME) September 2013 ReleaseEncounter Data Companion Guide – Professional (DME) July 2013 ReleaseEncounter Data Companion Guide – Institutional July 2013 ReleaseEncounter Data Companion Guide – Institutional September 2013 ReleaseEncounter Data Companion Guide – Institutional October 2013 ReleaseEncounter Data Companion Guide – Professional September 2013 ReleaseEncounter Data Companion Guide – Professional October 2013 ReleaseEncounter Data Companion Guide - Professional (DME) November 2013 ReleaseEncounter Data Companion Guide - Institutional November 2013 ReleaseEncounter Data Companion Guide – Professional (DME) December 2013 ReleaseRisk Adjustment for EDS and RAPS User Group - July 21, 20162014 Risk Adjustment Webinar Q&A - July 1, 2014Gentran Dataset NamesEncounter Data Companion Guide - Professional March 2015Encounter Data Companion Guide - Institutional March 2015EDIPPS Proposed SNF and HH Comments LetterEDPS Testing and Certification TimelinePACE Test Case Specifications - ProfessionalEncounter Data End to End Test PlanEDS Front-End Testing InstructionsPACE Front-End Industry Testing PackageEncounter Data Companion Guide - Professional (DME) April 2014 ReleasePACE Test Case Specifications - DMEPACE Test Case Specifications - InstitutionalPACE Test Case Specifications - DMEEncounter Data Test Case Specifications - InstitutionalEncounter Data Test Case Specifications - ProfessionalED Testing Schedule - RevisedEDDPPS Proposed Edit Comments LetterEDDPPS Proposed Edits Comments ToolEDDPPS Proposed Edits ToolEDIPPS Proposed SNF and HH Edits ToolEDIPPS SNF and HH Edits Comments ToolEncounter Data Test Case Specifications – DMEEncounter Data User Group – June 27, 2013Encounter Data Companion Guide – Professional (DME) September 2014 ReleaseAppendix 5A MAO-001 Report LayoutAppendix 5B MAO-002 Report LayoutAppendix 4B 999 Acknowledgement Report Key SegmentsAppendix 4C 277CA Acknowledgment Report Key SegmentsAppendix 4A TA1 Acknowledgement Report Key SegmentsEncounter Data Companion Guide – Professional (DME) January 2014 ReleaseEncounter Data Test Case Specifications - DMERisk Adjustment Methodology: An Overview of Risk Adjustment CBTRisk Adjustment Methodology: An Overview of Risk Adjustment CBT Text OnlyEncounter Data Institutional Test Case SpecificationsEncounter Data Professional Test Case SpecificationsEncounter Data Durable Medical Equipment Test Case SpecificationsRisk Adjustment Methodology Computer-Based Training (Text Only)Risk Adjustment Methodology Computer-Based TrainingAppendix 3B Crosswalk from Retired Minimum Data Element List to Appendix 3A MA Companion GuideAppendix 4A Deactivated EditsAppendix 3A MA Companion Guide: CMS' Supplemental Instructions for EDR & CRR Data ElementsAppendix 3C MBI Edits for Encounter Data and RAPS DataEncounter Data Submission and Processing GuideWhere can MAOs and other entities access the Risk Adjustment for EDS & RAPS User Group materials?How should MAOs report Medicare supplemental dental services to CMS?We are receiving error code 502 on RAPS file submissions. Duplicate error is caused by another plan submitting the diagnosis clusters. How can we resolve this issue and/or receive credit for the diagnosis clusters?When will the updated mappings for the 2020 CMS -HCC model be posted on the CMS website? Will the updates to the Health Insurance Claim Number (HICN) and social security number (SSN) fields for the 2020 MORs also apply to the 2019 MORs?Are encounter data records and chart review records with default NPIs for atypical providers considered for risk calculation?How should MAOs report annual wellness visits to CMS?How should an MAO Encounter Data Technical Contact ensure they are registered to receive HPMS communications?If the MAO-002 comes back with the encounter accepted but some of the service lines rejected, should we consider the encounter as rejected, requiring a void and replacement of the whole encounter?How should Medicare Advantage plans submit encounters for a supplemental gym membership?How is the EDPS ICN assigned?Can a Linked Chart Review Record use either the HICN or MBI when matching to an encounter (if the encounter uses the other beneficiary identifier)?Do Risk Adjustment filtering rules differ between PACE and typical Medicare Advantage plans?How should anesthesia claims with procedure code 01996 be submitted?Where are the ICD-10 to HCC mappings located?For replacement and void encounter data, if one of the key data fields is different from the original claim submitted, should the encounter be submitted as an original?How do MAOs and other entities access the CMS 5010 CEM Spreadsheet?What connectivity options can MAOs and other entities use to submit RAPS and EDS files?An MAO submitted a CRR Add that was linked to an original EDR. The linked CRR Add was accepted. The MAO then submitted a replacement of the EDR, and it was accepted. Because the linked CRR Add was submitted for the original EDR, will those CRR Add diagnoses now be linked to the replacement EDR?Why do some diagnoses appear on the MAO-004 reports showing as accepted and allowed, but do not appear on the 2019 Initial payment MOR?Does CMS use diagnosis codes submitted via an unlinked chart review for Risk Adjustment payments?Since the transition to the new MBI on April 2, 2018, can MAOs and other entities submit deletions for dates of service (DOS) before April 2, 2018 using the HICN?When deleting EDPS data, should plans use the same beneficiary identifiers (i.e. HICN or MBI) used to submit the original data?How should an MAO submit a linked chart review delete record that has an E code requiring deletion, where the E code is in the primary diagnosis position?Will CMS publish a list of risk adjustment eligible CPT/HCPCS codes? Will the MAO-004 report contain DME encounter services?Where can MAOs submit questions about RAPS and other risk adjustment issues?Does a linked chart review delete need a primary diagnosis code?When viewing the monthly Medicaid Status file, if the MMR and the Medicaid status files display different Medicaid status, which file's data should take precedence?Are all MAO-002 accepted encounter data records included in MAO-004 reports?How can MAOs or other entities determine which diagnosis codes are accepted on the Phase III MAO-004 Report?How does the MAO-004 report include diagnosis codes from both the original and replacement EDRs that are risk eligible?What will display in the Allowed/Disallowed Flag field 25 of the MAO-004 report when the Allowed/Disallowed Reason Codes field 27 contains value of Q?When will an accepted encounter diagnosis not display on the MAO-004 Report?Why would the MAO-004 report list a diagnosis as disallowed?CMS guidance allows MAOs and other entities, in certain circumstances, to add modifiers to lines within a record to bypass the line-level duplicate check, when each line represents a unique service. Is it acceptable for MAOs and other entities to modify the encounter on the backend for EDPS submission purposes? Or does the billing provider need to rebill with those modifiers?How can MAOs securely submit PII or PHI so that CMS may research issues?If the claim submitted by the provider to the MAO or other entity is still an original claim (for example, the provider needed to submit additional pre-authorization information, but the claim is still considered an original or the MAO or other entity has made claims adjustments in our system, but the provider did not submit a new claim), is it acceptable for the MAO or other entity to modify the claim frequency code of the encounter data record?We need to add or delete diagnoses from an already-submitted encounter data record. Are we allowed to change the diagnoses from what was submitted on the bill, or do we need to have the provider rebill the plan?Can MAOs and other entities submit End Stage Renal Disease (ESRD) information on behalf of dialysis centers?Where can we find guidance on how CMS implemented the MBI initiative for RAPS and EDS?Can CMS clarify the logic for EDPS error 01405 - Sanctioned Providers?How can MAOs and other entities become certified to submit encounter data?How can MAOs and other entities delete diagnosis codes from the Encounter Data System (EDS)?What is the difference between the Monthly Medicaid Status Report and the Medicaid flag on MMR?Are chart review records with default procedure codes and default NPI eligible for risk adjustment?Can CMS provide a default NPI for MAOs and other entities to use when submitting unlinked chart review records?Can CMS provide a default procedure code for MAOs and other entities to use when submitting unlinked chart review records?If an encounter data record meets the requirements for risk adjustment, are all diagnoses on the record considered for risk adjustment?On the MAO-004 Report, does the information in the Additional Diagnosis Codes field 35 apply to the diagnoses in the Current ICN field 9 or the diagnoses in the Prior Record ICN field 13?What are the circumstances where a single ICN can have 38 or more diagnoses as defined in field 35 - Additional Diagnosis Codes - of the MAO-004 report layout?How are encounter data submissions incorporated into risk score calculations?Where can MAOs and other entities find information on submission deadlines and payment dates?What are the submission timelines and deadlines for PACE?Are diagnosis codes submitted on chart review records included in MAO-004 Report data?Are there restrictions on the number of chart review delete records submitted to the EDPS?How can MAOs submit questions regarding MAO-004 reports that they did not receive, but believe they should have?How does CMS determine a diagnosis code's highest level of specificity for a specific beneficiary when generating edit 255 ‘Diagnosis Code’?If an MAO or other entity voids an accepted encounter containing rejected lines, and then submits a new, original encounter containing only the previously rejected (now corrected) lines, will the data submitted on the voided encounter be lost?MAOs are receiving EDFES edit 178 “Submitted Charges” when the charges exceed $99,999.00. Can CMS provide a prevention or resolution strategy for this edit?Should MAOs and other entities submit subsequent replacement encounters using the ICN of the original encounter or the ICN of the previous replacement encounter?What is the process to request a copy of a previously generated MAO-004 Report?Where can MAOs locate a complete list of CMS-acceptable HCPCS procedure and modifier codes?Will MAOs need to resubmit encounters to account for code set updates, or will CMS reprocess those encounters impacted by these updates?Will the EDS accept service lines with “S” and “G” procedure codes?Will the submission of duplicate diagnosis codes in the same EDR generate EDFES edit 255 - Diagnosis Code?How should submitters identify names containing special characters; for example, a name with the tilde character over the ‘n’?What is the cutoff time for RAPS and EDS submission deadlines?Will the MAO-004 report reflect diagnosis codes that are not risk adjustment eligible with a disallowed flag?Can the MAO or other entity populate the encounter data record with demographic information related to age, name, and sex that it knows to be correct, or should it only submit data sent to the MAO or other entity by the provider (which might be incorrect)?Should MAOs and other entities submit denied claims for processing?What are the acceptable TOB values for EDS Submissions?If MAOs submit an unlinked CRR that corresponds to an accepted EDR, will it result in a duplicate error?

Last Updated: 08/23/2019